High Purity Type I Collagen Based Skin Substitute Vs Dehydrated Human Amnion/Chorion Membrane in Treatment of DFUs

This is a randomized controlled clinical investigation in patients suffering from diabetic foot ulcers. The study intends to compare patient outcome data using Standard of Care with Type-I Collagen-based Skin Substitute and Standard of Care with Dehydrated Human Amnion/Chorion Membrane.

The purpose of this randomized controlled clinical study is to collect and compare patient outcome data at 4 weeks using Type-I Collagen-based Skin Substitute in one half of the patients and Dehydrated Human Amnion/Chorion Membrane in the other half.

Eligibility Criteria:
Inclusion Criteria:

* Subjects must be at least 18 years of age or older.
* Subjects must have a diagnosis of type 1 or 2 Diabetes mellitus.
* At randomization subjects must have a target diabetic foot ulcer with a minimum surface area of 1.0 cm2 and a maximum surface area of 10.0 cm2 measured post debridement using a ruler to measure wound area.
* The target ulcer must have been present for a minimum of 4 weeks and a maximum of 52 weeks of standard of care prior to the initial screening visit.
* The target ulcer must be located on the foot with at least 50% of the ulcer below the malleolus.
* The target ulcer must be full thickness on the foot or ankle that does not probe to bone.
* Adequate circulation to the affected foot as documented by any of the following methods performed within 3 months of the first screening visit:

  * Transcutaneous Oxygen Measurement (TCOM) ≥30 mmHg
  * Ankle-Brachial Index (ABI) between 0.7 and 1.3
  * Peripheral Vascular Resistance (PVR): Biphasic
  * Toe-Brachial Index (TBI) ˃0.6
  * As an alternative, arterial Doppler ultrasound can be performed evaluating for biphasic dorsalis pedis and posterior tibial vessels at the level of the ankle of the target extremity.
* If the subject has two or more ulcers, they must be separated by at least 2 cm. The largest ulcer satisfying the inclusion and exclusion criteria will be designated as the target ulcer.
* The subject must consent to using the prescribed off-loading method for the duration of the study.
* The subject must agree to attend the twice-weekly/weekly study visits required by the protocol.
* The subject must be willing and able to participate in the informed consent process.
* Patients must have read and signed the IRB approved ICF before screening procedures are undertaken.

Exclusion Criteria:

* A subject known to have a life expectancy of \<6 months.
* If the target ulcer is infected or if there is cellulitis in the surrounding skin.
* Presence of osteomyelitis or exposed bone, probes to bone or joint capsule on investigator's exam or radiographic evidence.
* A subject that has an infection in the target ulcer that requires systemic antibiotic therapy.
* A subject receiving immunosuppressants (including systemic corticosteroids at doses greater than 10 mg of Prednisone per day or equivalent) or cytotoxic chemotherapy.
* Topical application of steroids to the ulcer surface within one month of initial screening.
* A subject with a previous partial amputation on the affected foot is excluded if the resulting deformity impedes proper offloading of the target ulcer.
* A subject with a glycated hemoglobin (HbA1c) greater than or equal to 13% taken at or within 3 months of the initial screening visit.
* A subject with a serum creatinine ≥ 3.0mg/dL within 6 months of the initial screening visit.

  o A subject with an acute Charcot foot, or an inactive Charcot foot, that impedes proper offloading of the target ulcer.
* Women who are pregnant or considering becoming pregnant within the next 6 months.
* A subject with end stage renal disease requiring dialysis.
* A subject who participated in a clinical trial involving treatment with an investigational product within the previous 30 days.
* A subject who, in the opinion of the Investigator, has a medical or psychological condition that may interfere with study assessments.
* A subject treated with hyperbaric oxygen therapy or a Cellular and/or Tissue Product (CTP) in the 30 days prior to the initial screening visit.