Progress in the application of ablative fractional lasers in chronic wounds

This literature review aims to explore the application of ablative fractional laser in chronic wound healing, focusing on its clinical efficacy and mechanisms of action. Additionally, it summarizes the various lasers and parameters utilized by the authors in their studies. A comprehensive literature search was conducted for studies published between 2008 and 2025 in the Google Scholar, Web of Science, Medline, and PubMed databases, using the keywords: Fractional, Laser, Chronic Wounds, Ulcers, Healing. A substantial body of evidence suggests that carbon dioxide (CO₂) and erbium: yttrium aluminum garnet (Er: YAG) lasers can significantly accelerate the healing of chronic wounds. However, treatment protocols vary considerably across studies, particularly in terms of treatment frequency, power output, and energy density. This lack of standardization makes it challenging to compare outcomes directly and to determine optimal treatment parameters. The majority of studies conclude that CO₂ and Er: YAG laser therapies effectively promote the repair of chronic wounds. Proposed mechanisms include precise debridement, reduction of bacterial burden, improved local perfusion, enhanced transdermal drug delivery, and activation of key signaling pathways, such as Transforming growth factor-β/smad(TGF-β/Smad). Further research is needed to establish standardized treatment protocols and identify the most effective laser parameters for clinical use.