Chronic lower extremity ulcers (CLEUs) are notoriously difficult to treat due to prolonged inflammation, impaired microcirculation, and disrupted tissue repair mechanisms. In a 2017 prospective study published in Laser Therapy, Alcolea et al. evaluated the clinical efficacy of an Er:YAG 2940 nm laser equipped with RecoSMA (spatially modulated ablation) technology for the treatment of refractory chronic ulcers .
The study investigated whether a mechanically driven microablative laser approach could reactivate stalled healing processes in long-standing ulcers unresponsive to conventional therapy.
Study Design
All patients had previously failed multiple topical treatments. Active infections were excluded through serial cultures .
Treatment Protocol
Each patient received:
When keratin accumulation was present, superficial ablation was first performed without RecoSMA to remove devitalised tissue.
After treatment, ulcers were covered with polyurethane film and non-compressive bandage only — no additional topical products were allowed.
Technology: Er:YAG + RecoSMA
The Er:YAG laser (2940 nm) is highly absorbed by water, enabling precise superficial microablation.
RecoSMA technology:
The resulting mechanical-acoustic “pushing effect” stimulates:
Clinical Outcomes
1️⃣ Ulcer Area Reduction
Initial average area: 15.7 ± 8.4 cm²
After treatment:
Final average ulcer area (non-closed ulcers): 7.8 ± 7.5 cm²
Reduction in ulcer area was statistically significant (p = 0.05) .
2️⃣ Pain Reduction
Pain scale (1–10):
Pain reduction was statistically significant.
Interestingly, bleeding increased during treatment (interpreted as improved microvascular activation and tissue vitality).
3️⃣ Predictive Factors
Statistically significant predictors of better response:
Cardiovascular risk factors (diabetes, hypertension, dyslipidaemia, smoking) were not statistically significant in determining response under laser treatment .
Histological Findings
Biopsies were performed in 10 patients before treatment, at 6 weeks, and at 3 months.
Before treatment:
After 6 weeks:
After 3 months:
Importantly, no signs of thermal damage or fibrosis were observed .
Mechanism of Action
The authors propose that chronic ulcers remain “stuck” in a suppressed inflammatory state. RecoSMA-generated resonance waves:
The mechanical-acoustic effect differentiates this approach from traditional low-level laser photobiomodulation.
Safety and Tolerability
The absence of thermal damage significantly reduces morbidity risk.
Conclusion
The Er:YAG laser equipped with RecoSMA technology demonstrated a safe and effective alternative for the treatment of refractory chronic lower extremity ulcers.
In this cohort:
The study supports the role of mechanically modulated Er:YAG laser therapy as a promising regenerative approach in chronic ulcer management .
Source:
Alcolea JM, Hernández E, Martínez-Carpio PA, Vélez M, Khomchenko V, Sola A, Trelles MA. Treatment of Chronic Lower Extremity Ulcers with a New Er:YAG Laser Technology. Laser Therapy. 2017;26(3):211–222 .
The study investigated whether a mechanically driven microablative laser approach could reactivate stalled healing processes in long-standing ulcers unresponsive to conventional therapy.
Study Design
- Type: Prospective clinical study
- Patients enrolled: 18 (16 completed the study)
- Mean age: 66.3 ± 7.7 years
- Ulcer duration: ≥14 months (average 18.2 months)
- Ulcer types:
- 12 venous
- 4 mixed (arterial + venous)
- 2 lymphatic
All patients had previously failed multiple topical treatments. Active infections were excluded through serial cultures .
Treatment Protocol
Each patient received:
- 16 weekly treatment sessions (over 4 months)
- Laser irradiation covering the ulcer plus a 5 cm margin
- Energy dose: 3.2 J/cm²
- Frequency: 3 Hz
- Three passes per session with ~30% pulse overlap
When keratin accumulation was present, superficial ablation was first performed without RecoSMA to remove devitalised tissue.
After treatment, ulcers were covered with polyurethane film and non-compressive bandage only — no additional topical products were allowed.
Technology: Er:YAG + RecoSMA
The Er:YAG laser (2940 nm) is highly absorbed by water, enabling precise superficial microablation.
RecoSMA technology:
- Divides the beam into 10,000 microbeams/cm²
- Produces shallow epidermal ablation
- Generates mechanical-acoustic resonance waves
- Penetrates up to 6 mm into dermis
- Creates controlled microtrauma without thermal damage
The resulting mechanical-acoustic “pushing effect” stimulates:
- Neoangiogenesis
- Collagen remodelling
- Fibroblast activation
- Regeneration without fibrosis .
Clinical Outcomes
1️⃣ Ulcer Area Reduction
Initial average area: 15.7 ± 8.4 cm²
After treatment:
- 3 patients (18.75%) achieved complete closure
- 4 patients (25%) showed >75% reduction
- 2 patients (12.5%) had 50–75% reduction
- Over 65% of patients achieved ≥55% reduction
Final average ulcer area (non-closed ulcers): 7.8 ± 7.5 cm²
Reduction in ulcer area was statistically significant (p = 0.05) .
2️⃣ Pain Reduction
Pain scale (1–10):
- Initial: 4.4 ± 1.6
- Final: 2.3 ± 1.3
Pain reduction was statistically significant.
Interestingly, bleeding increased during treatment (interpreted as improved microvascular activation and tissue vitality).
3️⃣ Predictive Factors
Statistically significant predictors of better response:
- Younger age (p = 0.024)
- Shorter ulcer duration (p = 0.005)
Cardiovascular risk factors (diabetes, hypertension, dyslipidaemia, smoking) were not statistically significant in determining response under laser treatment .
Histological Findings
Biopsies were performed in 10 patients before treatment, at 6 weeks, and at 3 months.
Before treatment:
- Loss of epidermis
- Disorganised collagen
- Poor vascularisation
- Necrotic debris and pseudofibrosis
After 6 weeks:
- Disappearance of surface detritus
- Increased inflammatory infiltration
- Clear neoangiogenesis
After 3 months:
- Formation of granulation tissue
- Increased vascular density
- New collagen fibres with improved alignment
- Early re-epithelialisation
Importantly, no signs of thermal damage or fibrosis were observed .
Mechanism of Action
The authors propose that chronic ulcers remain “stuck” in a suppressed inflammatory state. RecoSMA-generated resonance waves:
- Reactivate the inflammatory phase
- Trigger microvascular recruitment
- Stimulate keratinocyte migration
- Promote collagen synthesis
- Facilitate granulation maturation
The mechanical-acoustic effect differentiates this approach from traditional low-level laser photobiomodulation.
Safety and Tolerability
- No anaesthesia required
- No complications reported
- Patients tolerated the procedure well
- No post-inflammatory hyperpigmentation
The absence of thermal damage significantly reduces morbidity risk.
Conclusion
The Er:YAG laser equipped with RecoSMA technology demonstrated a safe and effective alternative for the treatment of refractory chronic lower extremity ulcers.
In this cohort:
- Complete closure or >50% reduction was achieved in the majority of patients.
- Tissue regeneration was confirmed clinically and histologically.
- Healing was associated with microvascular activation and collagen remodelling rather than thermal destruction.
The study supports the role of mechanically modulated Er:YAG laser therapy as a promising regenerative approach in chronic ulcer management .
Source:
Alcolea JM, Hernández E, Martínez-Carpio PA, Vélez M, Khomchenko V, Sola A, Trelles MA. Treatment of Chronic Lower Extremity Ulcers with a New Er:YAG Laser Technology. Laser Therapy. 2017;26(3):211–222 .