Diabetic Foot Ulcer
Conditions
Brief summary
The Investigators plan to evaluate healing in two cohorts of patients with diabetic foot wounds (n=20) that receive optimal treatment including serial wound debridement and off-loading with a boot or postop shoe and AmnioEXCEL+. In one cohort, AmnioEXCEL+ will be applied weekly at study visits and in the second cohort, AmnioEXCEL+ will be applied maximum every 2 weeks (PRN, in the case that the wound requires debridement at a visit not intended for AE+ application, the wound will be treated as SOC). In addition, the Investigators will collect data on other potential confounding factors that could affect healing such as antibiotic, anti-fungal and anti-infective medications, tobacco, comorbidities, diabetes control, infection, perfusion, and activity. Wound healing, including wound size and adverse events will be evaluated.
Detailed description
Study Procedures: Collection of Demographic data, medical/social history Collection of medications1 Ankle Brachial Index2 Wound debridement3 (standard of care procedure) Imaging with eKare4 Hyperspectral Imaging Application of study product 1. Only collect antibiotics, anti-fungal and anti-infective medications. 2. ABI (with toe pressure) can be done at screening or baseline. 3. Once wound is healed, wound debridement will not be done at weekly visits. 4. Once wound is healed, eKare will not be done at weekly visits. 5. EOS will occur on the date the subject is healed. \*Screening and Visit 1 may be done on the same day. Screening and Enrollment\*: * Review and sign the Informed Consent and HIPAA Authorization * Review the inclusion and exclusion criteria If the subject qualifies for the study, they will participate in the following procedures (weekly visits, +/-4 days): Visit 1\*: * Demographics (such as age, gender, race or ethnicity) * Past Medical History, Social History, Medications documented. * Labs documented as SOC within 6mo of initial visit * ABI with toe pressures2 * Wound debridement * eKare wound measurement * Hyperspectral Imaging * Randomization * Application of AmnioEXCEL+ * Source documentation * Stipend disbursement Visits 2 through 6: * Wound debridement3 * eKare wound measurement4 * Hyperspectral imaging * Application of AmnioEXCEL+ per cohort assignment * Source documentation * Stipend disbursement Visit 7: * Medications documented * Wound debridement3 * eKare wound measurement4 * Hyperspectral imaging * Application of AmnioEXCEL+ per cohort assignment * Source documentation * Stipend disbursement Visits 8-11: * Wound debridement3 * eKare wound measurement4 * Hyperspectral Imaging * Application of AmnioEXCEL+ per cohort assignment * Source documentation * Stipend disbursement Visit 12: * Wound debridement3 * eKare wound measurement4 * Source documentation * Stipend disbursement End of Study (EOS) Visit 5: * Medications documented * Wound debridement3 * eKare wound measurement4 * Source documentation * Subject exit from study
Interventions
Amnio Excel + weekly
Amnio Excel + max every 2 weeks
Sponsors
Study design
Eligibility
Inclusion criteria
Criteria for Inclusion of Subjects: * 21-90 years of age * Able to provide informed consent * Chronic foot ulceration below the ankle - persistent for \>30 days but \<6 months Criteria for Exclusion of Subjects: * \<21 or \>90 years of age * Unable to provide informed consent * History of poor compliance in the opinion of the investigator * Gangrene * Untreated osteomyelitis * Widespread malignancy * Active alcohol or substance abuse such as cocaine, heroin, or methamphetamines that in the opinion of the investigator will impact the subject's participation in the study * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Healed | 12 weeks | Number of participants whose wounds healed during the study timeframe. Reported as dichotomous yes/no. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Wound Volume | Baseline | Wound volume measured by camera which performs a 3D measurement and calculates the volume at baseline |
| Wound Area | Baseline | Wound measured by camera which performs a 3D measurement and calculates the area at baseline |
| Tissue Oxygenation (StO2) of the Dorsal Foot | Baseline | Tissue oxygenation measured by hyperspectral imaging camera at baseline |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Weekly AmnioEXCEL+ Group AmnioEXCEL+ will be applied weekly at study visits
Amnio Excel + weekly: Amnio Excel + weekly | 20 |
| PRN AmnioEXCEL+ Group AmnioEXCEL+ will be applied maximum every 2 weeks (PRN, in the case that the wound requires debridement at a visit not intended for AE+ application, the wound will be treated as SOC)
Amnio Excel + max every 2 weeks: Amnio Excel + max every 2 weeks | 20 |
| Total | 40 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 3 | 3 |
| Overall Study | Withdrawal by Subject | 2 | 1 |
Baseline characteristics
| Characteristic | Weekly AmnioEXCEL+ Group | PRN AmnioEXCEL+ Group | Total |
|---|---|---|---|
| Age, Continuous | 58.9 years STANDARD_DEVIATION 15.3 | 57.6 years STANDARD_DEVIATION 9.8 | 58.43 years STANDARD_DEVIATION 12.7 |
| Body mass index | 32.2 kg/m^2 STANDARD_DEVIATION 7.8 | 32.3 kg/m^2 STANDARD_DEVIATION 5 | 32.3 kg/m^2 STANDARD_DEVIATION 6.6 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants | 4 Participants | 8 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 16 Participants | 16 Participants | 32 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Neuropathy | 18 Participants | 18 Participants | 36 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 4 Participants | 7 Participants | 11 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 15 Participants | 13 Participants | 28 Participants |
| Region of Enrollment United States | 20 participants | 20 participants | 40 participants |
| Sex: Female, Male Female | 6 Participants | 5 Participants | 11 Participants |
| Sex: Female, Male Male | 14 Participants | 15 Participants | 29 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 20 | 0 / 20 |
| other Total, other adverse events | 9 / 20 | 7 / 20 |
| serious Total, serious adverse events | 6 / 20 | 5 / 20 |
Outcome results
Number of Participants Who Healed
Number of participants whose wounds healed during the study timeframe. Reported as dichotomous yes/no.
Time frame: 12 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Weekly AmnioEXCEL+ Group | Number of Participants Who Healed | 6 Participants |
| PRN AmnioEXCEL+ Group | Number of Participants Who Healed | 10 Participants |
Tissue Oxygenation (StO2) of the Dorsal Foot
Tissue oxygenation measured by hyperspectral imaging camera at baseline
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Weekly AmnioEXCEL+ Group | Tissue Oxygenation (StO2) of the Dorsal Foot | 65.89 percentage of oxygen saturation | Standard Deviation 15.41 |
| PRN AmnioEXCEL+ Group | Tissue Oxygenation (StO2) of the Dorsal Foot | 65.70 percentage of oxygen saturation | Standard Deviation 9.31 |
Wound Area
Wound measured by camera which performs a 3D measurement and calculates the area at baseline
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Weekly AmnioEXCEL+ Group | Wound Area | 3.98 square centimeters | Standard Deviation 4.87 |
| PRN AmnioEXCEL+ Group | Wound Area | 3.15 square centimeters | Standard Deviation 4.05 |
Wound Volume
Wound volume measured by camera which performs a 3D measurement and calculates the volume at baseline
Time frame: Baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Weekly AmnioEXCEL+ Group | Wound Volume | 1.2 cubic centimeters | Standard Deviation 3.27 |
| PRN AmnioEXCEL+ Group | Wound Volume | 0.53 cubic centimeters | Standard Deviation 1.44 |