Erbium:Yttrium Aluminium Garnet (Er:YAG) Laser Therapy Versus Sharp Debridement in the Management of Chronic Ulcers of the Lower Extremity: A Randomised Control Trial

Abstract

Chronic wounds pose significant challenges to patients and potentially reduce patients' quality of life. A prospective randomised control trial (RCT) was conducted in Russia between 2018 and 2021 to assess the effectiveness of treating chronic wounds with a high-intensity Erbium: Yttrium Aluminium Garnet (Er:YAG with RecoSMA (Reconstructive Spatially Modulated Ablation module for distributing laser radiation into microbeams) laser technology versus sharp debridement in 144 patients (treatment group N = 71; control N = 73) with diabetic foot, venous and arterial leg ulcers. The median ulcer size at baseline in the treatment and control group was 11 cm² and 10 cm² with median ulcer duration of 16 months and 15 months, respectively. The endpoints were the time to achieve a clean wound bed, time to granulation, extent of complete and marginal epithelialisation, change in wound area, presence of bacteria, levels of topical wound pain, and the patients' tolerance of debridement. A difference at p < 0.05 was considered statistically significant. After a 30-day observation period, complete epithelialisation occurred in more than twice as many wounds in the treatment group (56.3%) compared to the control group (26%). The Er:YAG laser was more effective than sharp debridement in clearing wounds of microbial flora, stimulating tissue regeneration, promoting early granulation, marginal epithelialisation and wound healing, suggesting that Er:YAG laser therapy may offer greater benefits than conventional methods of sharp debridement of slow healing wounds.