Processed Amniotic Fluid (pAF) for the Treatment of Chronic Wounds

Study Overview
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Brief Summary
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A prospective randomized controlled study to determine the safety and feasibility of using processed amniotic fluid (pAF) to expedite healing in chronic wounds.

Detailed Description
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The goal of our study is to assess, in an outpatient setting, the safety and the time to wound closure in chronic wounds treated with processed amniotic fluid (pAF). We will include patients with lower extremity full thickness wounds that are greater than 3 months old and less than 12 months old. These wounds must have been unresponsive to other therapies, such as debridement, novel topical dressings, moist dressing, off-loading, and edema control, and the wound size must be greater than 5cm2 and less than 75 cm2. We will exclude anyone that has a thermal-related injury (burn or frostbite, etc.) or wounds over joints, requires skin grafting, or wounds with sinus tracts. Our primary objectives are to determine the safety and feasibility of using pAF to treat patients with chronic wounds by determining a reduction in wound size after application of pAF compared to standard of care.

Official Title
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A Phase I/II Clinical Trial To Determine Safety And Feasibility Of Using An Acellular Amniotic Fluid Application To Expedite Healing In Chronic Wounds

Conditions
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Wounds and Injuries

Intervention / Treatment
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* Drug: Processed Amniotic Fluid
* Other: Standard of Care Wound Treatment Regimen


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients 18-85 years old. Patients with chronic lower extremity wounds that are greater than 3 months, but less than 12 months old. Patients with full thickness wounds. Patients with at least one wound that is ≥5 cm2 and<75 cm2 in size. Patients who have failed previous traditional therapies (such as: standard of care, hyperbaric oxygen therapy, debridement, moist dressings, off-loading and edema control). Exclusion Criteria: Patients admitted to the hospital at the time of enrollment. Patients who are pregnant, nursing or plan to become pregnant while participating in the study. If of child-bearing potential, unwillingness to use effective birth control while participating in the study. Suspicion of or diagnosis of osteomyelitis underlying the wound. Patients who have received an investigational agent or intervention within the prior 30 days or plan to use within the study period. Patients with thermal-related injuries, such as burns or frostbite or wounds over joints. Patient with sinus tracts, enterocutaneous fistulas or other epithelialized tracts. Patients who require skin grafting. Patients diagnosed with a highly disruptive, non-controlled mental health disorder (e.g.., bipolar, or schizophrenia. Patients with a history of prior drug abuse.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Amniotic Fluid Injection<br>Processed Amniotic Fluid. Dose is 1ml/5cm2; Route: injected directly into wound; Limited to two injections. The wound will then be dressed according to standard of care. | Drug: Processed Amniotic Fluid<br>* Injection of 1 ml of processed amniotic fluid per 5 cm2 of wound area<br>* Other names: Human Amniotic Fluids (hAF);|
| Active Comparator: Standard of Care Wound Treatment Regimen<br>Primary dressings are variable and based on the moisture content and microorganism load. In general, wounds respond differently to various topical treatments. Through our clinical practice, we have found that wounds plateau with the same topical for greater than 4 weeks, hence changing antimicrobial topical helps to manage the bacterial overgrowth. We will start with our application of our slurry, a 1:1:1 ratio of Nystatin ointment, Mupirocin Ointment, and Bacitracin Ointment. This slurry will be applied directly to the cleansed wound, followed by silver gauze/foam product to all wounds. Types of silver product- site and comfort predict use of Restore, Mepilex-AG, or Mepitel-AG. If allergies to the above slurry occurs, we will use medical honey with or without bacitracin. If ointment related rash present with transition to silver product only or silver product plus medical honey. | Other: Standard of Care Wound Treatment Regimen<br>* ointment-based dressing and non-ointment-based dressings<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety - adverse events including serious adverse events | Safety and tolerability will be evaluated by the PI from the results of reported signs and symptoms and scheduled physical examinations. Unresolved AE's will be monitored for 1 year. | Up to 1 year after the last study visit. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility - reduction in wound size | The percent reduction in wound area at Visit 5 (final visit) relative to the size at randomization visit. Wound surface area will be calculated and maximal wound depth will also be measured using ImageJ overlay software technology. | Up to 8 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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chronic wounds