When vascular or diabetic foot surgeons hear “laser therapy for wounds,” most immediately think of low-level photobiomodulation. Gentle light. Adjunct therapy. That is not what we are discussing.
The issue is not simply "cellular activation". Neuroischemic ulcers are not superficial inflammatory lesions. They are hypoxic, colonised, fibrotic environments with impaired microcirculation and structurally altered extracellular matrix.
In daily practice, debridement is performed with a scalpel, curette, or hydrosurgical system. It is effective, but highly operator-dependent. In ischemic tissue, it is difficult to control how much marginally viable tissue is sacrificed. The clinical challenge is clear: remove necrotic zones and biofilm while preserving every millimetre of viable microvascular bed.
A short-pulse Er: YAG laser enables high-precision microablation with minimal thermal diffusion. Tissue interaction is dominated by cavitation rather than heat spread. This enables controlled removal of pathological surface tissue without extending injury into deeper ischemic layers.
But a structural reset alone is not enough.
After precise micro-ablation, tissue still needs to re-enter an active regenerative state. This is where RecoSMA becomes relevant.
RecoSMA is a spatially modulated Er: YAG application that creates thousands of controlled microinteractions across the wound surface. The effect is non-thermal and acoustically mediated. Instead of coagulation, it induces deep micro-stimulation within the tissue, supporting neovascularisation, fibroblast activation, organised granulation, and the transition from stalled chronic inflammation to regenerative repair.
In ischemic diabetic foot ulcers, this dual approach — precise non-thermal sanitation followed by regenerative activation — addresses both sides of the problem: the removal of the pathological substrate and the re-initiation of healing biology.
We expect this combination of high-precision micro-ablation and non-thermal regenerative stimulation to redefine how laser technology is integrated into advanced wound care. Not as adjunctive phototherapy, but as an active structural and biological intervention — potentially setting a new standard for regenerative management of complex ischemic wou
The issue is not simply "cellular activation". Neuroischemic ulcers are not superficial inflammatory lesions. They are hypoxic, colonised, fibrotic environments with impaired microcirculation and structurally altered extracellular matrix.
In daily practice, debridement is performed with a scalpel, curette, or hydrosurgical system. It is effective, but highly operator-dependent. In ischemic tissue, it is difficult to control how much marginally viable tissue is sacrificed. The clinical challenge is clear: remove necrotic zones and biofilm while preserving every millimetre of viable microvascular bed.
A short-pulse Er: YAG laser enables high-precision microablation with minimal thermal diffusion. Tissue interaction is dominated by cavitation rather than heat spread. This enables controlled removal of pathological surface tissue without extending injury into deeper ischemic layers.
But a structural reset alone is not enough.
After precise micro-ablation, tissue still needs to re-enter an active regenerative state. This is where RecoSMA becomes relevant.
RecoSMA is a spatially modulated Er: YAG application that creates thousands of controlled microinteractions across the wound surface. The effect is non-thermal and acoustically mediated. Instead of coagulation, it induces deep micro-stimulation within the tissue, supporting neovascularisation, fibroblast activation, organised granulation, and the transition from stalled chronic inflammation to regenerative repair.
In ischemic diabetic foot ulcers, this dual approach — precise non-thermal sanitation followed by regenerative activation — addresses both sides of the problem: the removal of the pathological substrate and the re-initiation of healing biology.
We expect this combination of high-precision micro-ablation and non-thermal regenerative stimulation to redefine how laser technology is integrated into advanced wound care. Not as adjunctive phototherapy, but as an active structural and biological intervention — potentially setting a new standard for regenerative management of complex ischemic wou
Clinical Case
A 48-year-old female patient presented with a right plantar hindfoot ulcer of three weeks’ duration and an initial wound surface area of 42 cm². The patient was treated using a two-step Er:YAG laser protocol combined with RecoSMA technology, as described by Chilgar and Andurkar in the Journal of Wound Care (2023) .
At each weekly outpatient session, the wound was cleansed with saline and measured prior to treatment. Step one consisted of short-pulse, high-power Er:YAG laser ablation (2940 nm) to precisely debride necrotic tissue and disrupt biofilm. Ablation was continued until capillary bleeding indicated viable tissue had been reached, effectively transitioning the wound into an active healing phase without the need for surgical sharp debridement or anaesthesia.
Step two involved biostimulation using spatially modulated RecoSMA technology. Laser energy was delivered in a microbeam pattern to the wound bed, edges, and surrounding periwound tissue. This created controlled micro-mechanical effects in deeper layers, reactivating the inflammatory cascade and promoting neovascularisation, collagen synthesis, extracellular matrix remodelling, and granulation tissue formation.
Standard wound care was maintained throughout, including alternate-day dressings, topical antiseptics, offloading to reduce plantar pressure, and systemic therapy when indicated. The patient underwent six laser sessions and achieved complete wound closure within seven weeks. Follow-up at 62 months demonstrated sustained healing without recurrence, supporting the effectiveness of the Er:YAG and RecoSMA two-step approach for diabetic plantar ulcers.
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, October):S21–S29 .
At each weekly outpatient session, the wound was cleansed with saline and measured prior to treatment. Step one consisted of short-pulse, high-power Er:YAG laser ablation (2940 nm) to precisely debride necrotic tissue and disrupt biofilm. Ablation was continued until capillary bleeding indicated viable tissue had been reached, effectively transitioning the wound into an active healing phase without the need for surgical sharp debridement or anaesthesia.
Step two involved biostimulation using spatially modulated RecoSMA technology. Laser energy was delivered in a microbeam pattern to the wound bed, edges, and surrounding periwound tissue. This created controlled micro-mechanical effects in deeper layers, reactivating the inflammatory cascade and promoting neovascularisation, collagen synthesis, extracellular matrix remodelling, and granulation tissue formation.
Standard wound care was maintained throughout, including alternate-day dressings, topical antiseptics, offloading to reduce plantar pressure, and systemic therapy when indicated. The patient underwent six laser sessions and achieved complete wound closure within seven weeks. Follow-up at 62 months demonstrated sustained healing without recurrence, supporting the effectiveness of the Er:YAG and RecoSMA two-step approach for diabetic plantar ulcers.
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, October):S21–S29 .
