Spatially Modulated Er:YAG Laser as a Treatment for Diabetic Foot Ulcers
2023-11-15 19:52
Diabetic foot ulcers (DFUs) remain one of the most severe and costly complications of diabetes, often leading to prolonged morbidity, infection, hospitalisation, and even amputation. In a 2023 study published in the Journal of Wound Care, Chilgar and Andurkar evaluated the effectiveness of spatially modulated Er:YAG laser therapy in the treatment of hard-to-heal diabetic ulcers .
This single-arm clinical study investigated whether combining laser debridement with deep tissue biostimulation could achieve complete wound closure without surgical intervention.
Study Overview
Design: Prospective single-arm clinical study
Setting: Plastic Surgery Department, Elrevo Clinic, India
Study period: November 2017 – April 2023
Sample size: 59 patients with diabetic ulcers
Primary endpoint: Complete wound closure
Secondary endpoints: Time to closure, number of laser sessions
Patients were included if they had hard-to-heal diabetic ulcers and were willing to continue treatment until full healing occurred. Ulcers were classified according to Wagner grading.
Patient Characteristics
Mean wound surface area at baseline: 25.7 cm² (median 12 cm²)
Average ulcer duration: 34 weeks
Most common location: Right plantar forefoot (27.1%)
This stage removed necrotic tissue and biofilm via rapid tissue vaporisation (>300°C), without causing thermal damage to surrounding viable tissue. The procedure was performed in an outpatient setting without the need for anaesthesia.
🔹 Step 2 – RecoSMA Biostimulation
Frequency: 3 Hz
Energy density: 2.30 J/cm²
Contact application
Treatment of wound bed, edges, and 3 cm periphery
RecoSMA technology divides laser energy into multiple microbeams, producing mechanical microdestruction and acoustic resonance in deeper tissues. This re-triggers the inflammatory phase of healing, stimulates neovascularisation, enhances collagen synthesis, and promotes extracellular matrix remodelling.
Standard Wound Care
In addition to laser therapy, patients received:
Alternate-day dressing changes
Topical antiseptics
Oral antibiotics when indicated (62.7%)
Offloading for plantar ulcers
Clinical photographic documentation during each session
Results
1️⃣ Complete Healing Achieved in All Patients
All 59 diabetic ulcers healed completely by the end of treatment.
Average number of sessions: 4.41 (range 1–11)
Majority (69.5%) required ≤5 sessions
Wound size reduced progressively with each treatment
This represents a 100% closure rate within the treated cohort .
2️⃣ Factors Influencing Number of Sessions
Statistically significant factors associated with needing more sessions:
Initial wound surface area >25 cm² (p=0.001)
Presence of oedema (p=0.007)
Hypertension (p=0.027)
Smaller wounds achieved closure more rapidly.
3️⃣ Long-Term Follow-Up
Follow-up range: 4–70 months
Average follow-up: ~23 months
Recurrence rate: 0% at the same site
This suggests durable healing and sustained tissue regeneration.
Mechanism of Action
The study highlights a synergistic dual mechanism:
Laser Ablation
Precise removal of necrotic tissue and biofilm
Reduced microbial burden
Minimal collateral damage
RecoSMA Biostimulation
Mechanical cavitation effect in deeper tissue
Reactivation of inflammatory cascade
Stimulation of fibroblast proliferation
Enhanced collagen and ECM formation
The authors describe this as a “holistic solution” combining wound cleansing and activation of endogenous healing pathways .
Clinical Implications
This study suggests that spatially modulated Er:YAG laser therapy:
Can achieve complete closure of diabetic ulcers up to 25 cm² without surgery
May reduce need for operating theatre-based sharp debridement
Provides outpatient, minimally invasive treatment
Demonstrates long-term durability of healing
Given the high amputation risk associated with diabetic ulcers, these findings are clinically significant.
Limitations
The authors acknowledge:
Single-arm design (no control group)
Moderate sample size
Potential variability in wound measurement
No histological confirmation of regenerated tissue
Limited generalisability
Further multicentre controlled studies are recommended.
Conclusion
In this prospective clinical study, spatially modulated Er:YAG laser therapy achieved complete wound closure in all 59 hard-to-heal diabetic ulcers with an average of 4.4 treatment sessions. The two-step protocol combining laser ablation and RecoSMA biostimulation appears to offer a promising, non-surgical approach to diabetic foot ulcer management. Source:
Chilgar RM, Andurkar SP. Spatially modulated erbium YAG laser as a treatment for diabetic ulcer. Journal of Wound Care. 2023;32(Silk Road Supplement):S21–S29 .
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