Chronic lower extremity ulcers (CLEU) are highly prevalent, multifactorial lesions that often remain refractory to standard therapy. In 2015, Hernández et al. published a prospective clinical study in Cirugía Plástica Ibero-Latinoamericana evaluating the effectiveness of an Er:YAG 2940 nm laser equipped with RecoSMA (spatially modulated ablation) technology in the management of chronic lower limb ulcers .
The study explored whether the mechanical-acoustic resonance effect produced by RecoSMA could reactivate stalled wound healing processes in chronic ulcers.
Study Design
Patients had chronic ulcers refractory to at least 2 months of standard treatment and no active infection at inclusion .
Treatment Protocol
Patients underwent:
No topical products were allowed post-treatment; ulcers were covered with paraffin gauze only.
All patients completed the protocol without dropouts or complications.
Technology Overview: Er:YAG + RecoSMA
The Er:YAG laser (2940 nm) is strongly absorbed by water, enabling precise microablation.
RecoSMA technology:
Histology confirmed:
Clinical Results
1️⃣ Ulcer Size Reduction
At 12 weeks:
This outcome was statistically significant (p < 0.05).
Computerised image analysis confirmed objective reduction in ≈80% of patients, with ≈26% complete closure detected digitally .
2️⃣ Pain Reduction
Pain (scale 1–10):
Pain decreased significantly.
Bleeding increased during treatment (from 3.53 to 6.29), interpreted as improved vascular activation and microcirculation.
3️⃣ Predictive Factors
Statistically significant predictors of effective reduction (>50%):
Other factors were not statistically significant .
Histological Findings
Before treatment:
After 6 weeks:
After 12 weeks:
The histological evidence supports mechanical regeneration rather than thermal damage .
Mechanistic Interpretation
Chronic ulcers remain trapped in a stalled inflammatory state. RecoSMA’s mechanical-acoustic resonance:
The regenerative response is attributed to mechanical microtrauma and resonance waves rather than photothermal effects.
Safety Profile
Treatment was well tolerated.
Clinical Implications
This study demonstrates that Er:YAG laser combined with RecoSMA technology:
Although not directly evaluated, the authors suggest potential cost-reduction benefits due to faster healing and absence of complications.
Conclusion
In this prospective study, Er:YAG laser with RecoSMA technology proved to be an effective and safe alternative for refractory chronic lower extremity ulcers. More than half of treated patients achieved complete closure or ≥50% reduction in ulcer size after 12 weeks.
The mechanical-acoustic resonance mechanism appears to stimulate deep dermal regeneration without thermal injury, offering a promising regenerative approach for chronic ulcer management .
Source:
Hernández E, Khomchenko V, Sola A, Pikirenia II, Alcolea JM, Trelles MA. Tratamiento de las úlceras crónicas de las piernas con láser de Er:YAG y tecnología RecoSMA. Cirugía Plástica Ibero-Latinoamericana. 2015;41(3):117–126 .
The study explored whether the mechanical-acoustic resonance effect produced by RecoSMA could reactivate stalled wound healing processes in chronic ulcers.
Study Design
- Type: Prospective clinical study
- Patients: 17 (15 women, 2 men)
- Mean age: 69 years (range 50–87)
- Average ulcer duration: 10.65 months
- Average initial ulcer size: 15.88 cm² (range 2–36 cm²)
- Ulcer types:
- 14 venous (82.4%)
- 2 mixed
- 1 lymphatic
Patients had chronic ulcers refractory to at least 2 months of standard treatment and no active infection at inclusion .
Treatment Protocol
Patients underwent:
- 12 weekly sessions (over 3 months)
- Dose: 3.2 J/cm²
- Frequency: 3 Hz
- Three passes per session
- Treatment area extended 5 cm beyond ulcer margins
No topical products were allowed post-treatment; ulcers were covered with paraffin gauze only.
All patients completed the protocol without dropouts or complications.
Technology Overview: Er:YAG + RecoSMA
The Er:YAG laser (2940 nm) is strongly absorbed by water, enabling precise microablation.
RecoSMA technology:
- Converts the beam into 10,000 microbeams/cm²
- Produces superficial epidermal microablation
- Generates mechanical-acoustic resonance waves
- Penetrates up to 6 mm into dermis
- Stimulates regeneration without thermal damage
Histology confirmed:
- Fine epidermal ablation without coagulation
- Dermal “gelation” (hyalinisation) phenomenon
- No residual thermal effect .
Clinical Results
1️⃣ Ulcer Size Reduction
At 12 weeks:
- 4 patients (23.5%) achieved complete closure
- 4 patients (23.5%) had >75% reduction
- 2 patients (11.8%) had 50–75% reduction
- Over 50% of patients achieved ≥50% reduction
This outcome was statistically significant (p < 0.05).
Computerised image analysis confirmed objective reduction in ≈80% of patients, with ≈26% complete closure detected digitally .
2️⃣ Pain Reduction
Pain (scale 1–10):
- Initial: 4.7
- Final: 3.06
Pain decreased significantly.
Bleeding increased during treatment (from 3.53 to 6.29), interpreted as improved vascular activation and microcirculation.
3️⃣ Predictive Factors
Statistically significant predictors of effective reduction (>50%):
- Age (p = 0.024)
- Ulcer duration (p = 0.005)
- Hypertension (p = 0.015)
- Diabetes (p = 0.015)
Other factors were not statistically significant .
Histological Findings
Before treatment:
- Absence of epidermis
- Disorganised collagen
- Poor vascularisation
- Chronic inflammatory infiltrate
- Pseudofibrosis
After 6 weeks:
- Disappearance of detritus
- Strong inflammatory infiltrate
- Active neoangiogenesis
- Capillary proliferation
After 12 weeks:
- Granulation tissue formation
- Rich vascular dermis
- Early epithelial cell migration
- New vertical and parallel collagen fibres
- No fibrosis
- No thermal injury
The histological evidence supports mechanical regeneration rather than thermal damage .
Mechanistic Interpretation
Chronic ulcers remain trapped in a stalled inflammatory state. RecoSMA’s mechanical-acoustic resonance:
- Re-triggers the inflammatory phase
- Activates microvascular formation
- Promotes fibroblast proliferation
- Stimulates collagen synthesis
- Facilitates keratinocyte migration
The regenerative response is attributed to mechanical microtrauma and resonance waves rather than photothermal effects.
Safety Profile
- No anaesthesia required
- No complications reported
- No post-inflammatory hyperpigmentation
- No fibrosis observed
Treatment was well tolerated.
Clinical Implications
This study demonstrates that Er:YAG laser combined with RecoSMA technology:
- Offers a non-invasive regenerative alternative
- Can prepare ulcers for grafting or achieve closure
- Reactivates stalled wound healing
- Provides a safe outpatient option
Although not directly evaluated, the authors suggest potential cost-reduction benefits due to faster healing and absence of complications.
Conclusion
In this prospective study, Er:YAG laser with RecoSMA technology proved to be an effective and safe alternative for refractory chronic lower extremity ulcers. More than half of treated patients achieved complete closure or ≥50% reduction in ulcer size after 12 weeks.
The mechanical-acoustic resonance mechanism appears to stimulate deep dermal regeneration without thermal injury, offering a promising regenerative approach for chronic ulcer management .
Source:
Hernández E, Khomchenko V, Sola A, Pikirenia II, Alcolea JM, Trelles MA. Tratamiento de las úlceras crónicas de las piernas con láser de Er:YAG y tecnología RecoSMA. Cirugía Plástica Ibero-Latinoamericana. 2015;41(3):117–126 .