Comparison of Human Allograft to Apligraf for Venous Leg Ulcers

The products to be considered will be Apligraf, which is a bioengineered skin substitute,
and TheraSkin, which is a cryopreserved split-thickness human skin allograft. This is a
head-to-head designed study to observe the performance of each product and compare the
results so that the clinician can readily see advantages in healing times, infection rates,
and costs associated with each product. The study sponsors are Soluble Systems and Life Net
Health.

The Study will have three phases:

The first phase will consist of a series of screening assessments designed to determine
eligibility. The prospective patients must meet inclusion and exclusion criteria. They will
be randomly assigned to one of the two cohorts in equal numbers.

In the second phase, the study treatment will be administered and the patient will be
followed until the study ulcer has completely healed (i.e., 100% closure as determined by
the Investigator, for up to 12 weeks. During the Treatment Phase subjects will be evaluated
on a weekly basis. Efficacy evaluations each week will include Investigator assessment of
wound closure and evaluations of ulcer size.

During the third phase, which will immediately follow the initial 12 weeks of the second
phase, all patients remaining with non-healed study wounds will be treated and followed
through an additional 8 weeks of treatment.

Safety Assessments throughout the study will include assessment of adverse events and
measurement of clinical laboratory parameters.

STUDY ENROLLMENT This study will initially include 100 subjects, enrolled randomly into two
groups, to be treated with either Apligraf or TheraSkin. The sample size was determined with
a power calculation based on the anticipated difference in healing rate between Apligraf and
TheraSkin. The following parameters were used to calculate the sample size. The literature
on these two products predicts a closure rate of 68% with TheraSkin, and 47% for Apligraf
within 12 weeks.

Assuming a 68% closure rate with TheraSkin, and a 47% closure rate, with a desired alpha
value of p<0.05 and a power of 80%, 64 subjects would be needed. However, if a difference in
closure rate is assumed to be only 10%, with a closure rate of 68% with TheraSkin and 47%
with Apligraf, the power calculation predicts that 142 subjects would be needed. A
compromise difference of 13% was used to predict that 84 subjects would be needed. If we
assume a 20% dropout rate due to lack of compliance or adverse events, we will need to
enroll a total of 100 subjects.

Inclusion Criteria:Inclusion Criteria: Subjects are required to meet all of the following
inclusion criteria for study enrollment and subsequent randomization.

1. A signed and dated informed consent form has been obtained from the subject.

2. Subject is 18yrs or older and able and willing to comply with study procedures.

3. Ulcer size (area) is >2cm2 but <40cm2 (post-debridement at time of randomization) and
not deeper than 5mm.

4. Study ulcer duration is >30days despite conventional wound care at the time of
screening visit.

Note: If the subject has more than one qualifying VLU, the ulcer designated as the study
ulcer will be at the discretion of the Investigator.

5. Subject has adequate arterial perfusion with an ankle brachial index >0.5 or biphasic
or triphasic Doppler signals in the dorsalis pedis and posterior tibial arteries of the
affected extremity.

Exclusion Criteria:Exclusion Criteria: Subjects meeting any of the following criteria will
be excluded from enrollment and subsequent randomization.

1. Subject has suspected gangrene or wound infection on any part of the affected limb.
(Subjects with wound infection at the screening visit may be treated and re-screened
for participation in the study after eradication of the infection).

2. Subject has a history of hypersensitivity to bovine collage and agarose shipping
media as listed in the Apligraf directions for use.

3. Subject has a history of hypersensitivity to any of the antibiotics or preservation
agents listed in the TheraSkin Instructions for Use.

4. Subject was previously treated under this clinical study protocol.

5. Subject has participated in another clinical trial involving a device or a
systemically administered investigational study drug/treatment within 30 days of
randomization visit.

6. Subject is currently receiving (i.e., within 30 days of randomization visit) or
scheduled to receive a medication or treatment which, in the opinion of the
Investigator, is known to interfere with or affect the rate and quality of wound
healing (e.g., systemic steroids, immunosuppressive therapy, autoimmune disease
therapy, cytostatic therapy within the 12 months prior to randomization, dialysis,
radiation therapy to the foot, vascular surgery, angioplasty or thrombolysis).

7. Subject has ulcers secondary to a disease other than venous ulcers, e.g., vasculitis,
neoplasm's, or hematological disorders.

8. Subject has osteomyelitis with necrotic soft bone. (If the Investigator suspects the
presence of osteomyelitis, the diagnosis must be confirmed by plain film X-ray.)

9. Subject has a history of bone cancer or metastatic disease on the affected limb,
radiation therapy to the foot or has had chemotherapy within the 12 months prior to
randomization.

10. Subject has been treated with wound dressings that include growth factors, engineered
tissues, or skin substitutes (e.g., Regranex®, Dermagraft®, Apligraf®, TheraSkin®,
GraftJacket®, OASIS®, Primatrix®, Matristem®, etc.) within 30 days of randomization.

11. Subject has a history of or any of the following current illnesses or conditions
(other than diabetes) that would compromise the safety of the subject, or the normal
wound healing process:

1. End-stage renal disease

2. Immunosuppression

3. Severe malnutrition