Er:YAG laser Therapy for Diabetic Foot Ulcers: A Pilot Study with Hyperspectral Imaging Assessment

Diabetic foot ulcers (DFU) are associated with impaired wound healing and high morbidity. Er:YAG laser therapy has been proposed as an adjunctive treatment due to its ablative and biostimulatory properties. The aim of this study was to explore the feasibility and preliminary clinical and physiological responses to adjunctive Er:YAG laser therapy in DFUs using hyperspectral imaging (HSI). A pilot study including five patients with DFU was conducted. All patients received Er:YAG laser therapy once weekly for 8 weeks in addition to standard of care. Clinical outcomes included wound area and wound-bed quality assessed using the Wollina wound score. Physiological responses were evaluated using HSI-derived parameters, including tissue oxygen saturation, oxyhemoglobin, deoxyhemoglobin, and total hemoglobin, measured before and after laser treatment sessions. Wound area showed a progressive reduction during follow-up, with a mean percentage wound area reduction of 33.06 ± 44.9% at week 8. Wound-bed condition improved significantly over time, with the Wollina wound score increasing from a median of 5 at baseline to 7 at week 8 (p = 0.024). HSI analysis demonstrated significant and sustained increases in THb and OxyHb at weeks 4 and 8 compared with baseline values (p < 0.05), indicating improved tissue perfusion and oxygen delivery. These preliminary findings suggest that adjunctive Er:YAG laser therapy was feasible and showed promising improvements in wound-bed quality and perfusion-related HSI parameters, alongside clinically meaningful wound size reduction. HSI appears to be a promising tool for the objective assessment of physiological responses to therapy.