Trial of Dehydrated Human Amnion/Chorion Membrane (dHACM) In the Management of Diabetic Foot Ulcers

Inclusion Criteria:

1. Male or female age 18 or older.

2. The patient is willing and able to provide informed consent and participate in all
procedures and follow up evaluations necessary to complete the study.

3. Patient's ulcer must be diabetic in origin with a size ranging from 1 to 25 cm2.
Debridement will be done prior to randomization, if clinically indicated.

4. Wounds should be diabetic foot ulcers located on the dorsal or plantar surface of the
foot.

5. Patients with Type 1 or 2 diabetes (criteria for the diagnosis of diabetes mellitus
per ADA).

6. Ulcer must be present for a minimum of 30 days before enrollment/randomization, with
documented failure of prior treatment to heal the wound (≤25% wound area reduction
after 14 consecutive days of therapy immediately prior to randomization when treated
with standard protocol of care).

7. Affected leg has been offloaded (removable walker or total contact cast) for >14
consecutive days prior to randomization.

8. Serum Creatinine less than 3.0mg/dl (within last 6 months).

9. HbA1c less than 12% within previous 60 days.

10. Patient has adequate circulation to the affected extremity, as demonstrated by one of
the following within the past 60 days:

- Dorsum transcutaneous oxygen test (TcPO2) with results ≥30mmHg, OR

- ABIs with results of ≥0.7 and ≤1.2, OR

- Doppler arterial waveforms, which are triphasic or biphasic at the ankle of
affected foot.

11. Females of childbearing potential must be willing to use acceptable methods of
contraception (birth control pills, barriers, or abstinence).

Exclusion Criteria:

1. Patients presenting with an ulcer probing to bone (UT Grade IIIA-D). A positive
probe-tobone will be confirmed when bone or joint can be felt with a sterile,
ophthalmological probe.

2. Patients with multiple wounds on the same foot where other wounds are within 3 cm of
the wound under care.

3. Patients considered not in reasonable metabolic control, confirmed by an HbA1c 12% or
greater at any time within previous 60 days.

4. Known history of poor compliance with medical treatments.

5. Patients currently enrolled in this study. Concurrent enrollment in the study is
prohibited.

6. Patients treated with investigational drug(s) or therapeutic device(s) within 30 days.

7. Patients currently receiving radiation therapy or chemotherapy.

8. Known or suspected local skin malignancy to the index diabetic ulcer.

9. Patients diagnosed with autoimmune connective tissue diseases.

10. Non-revascularizable surgical sites.

11. Active infection at index site or currently being treated with antibiotics

12. Any pathology that would limit the blood supply and compromise healing.

13. Patients that have received a biomedical or topical growth factor for their wound
within the previous 30 days. Study ulcer has been previously treated with tissue
engineered materials (e.g. Apligraf® or Dermagraft®) or other scaffold materials (e.g.
Oasis, Matristem) within the last 30 days.

14. Patients who are known to be pregnant, plan to become pregnant, or are breast feeding.

15. Known allergy to Gentamicin sulfate or Streptomycin sulfate.

16. Active Charcot deformity or major structural abnormalities of the foot.

17. Wounds that are greater than one year in duration without intermittent closure.