Scientific Publications

Er:YAG Laser and RecoSMA Technology in the Treatment of Chronic Lower Extremity Ulcers

2016-09-15 09:33
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

  • 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 .