The purpose of this clinical investigation is to assess performance of the Medaxis Debritom+™ and to collect subject outcome data in the treatment of diabetic foot ulcers (DFU) vs Standard sharp debridement.
The economic burden of DFUs costs the United States over $50 billion each year. The cost to treat one subject with DFUs ranges from $11,700 to $16,883. Although approximately 70% of DFUs are shown to heal with good SOC, at least 30% become chronic wounds. These non-healing wounds are at greater risk for infection and lower extremity amputation. Consequently, good standard of care therapy is important for subjects with chronic DFUs to improve subject outcomes, lower treatment costs and reduce the risk of complications. The removal of necrotic tissue such as slough, eschar, and underlying biofilm constitutes one of the most important parts of standard of care (SOC). Currently, a variety of techniques are used to debride chronic wounds, such as larval therapy, autolytic and enzymatic methods, monofilament polyester fiber pads or brushes, and mechanical debridement with curettes and scalpels. It has also been demonstrated that more frequent debridement, on average, results in faster wound healing. While regarded as the "gold standard," sharp debridement requires considerable experience of clinicians to ensure that contaminated and devitalized tissue is entirely removed without extensively damaging surrounding healthy tissue. Moreover, a recent research has demonstrated that even when surgical debridement is well-conducted so that it removes the majority of biofilm, within 72 hours, biofilm often re-establishes itself. Given that perhaps 60% of chronic wounds have been found to harbor biofilm, it is challenging to keep such wounds free of biofilm so that the wound-healing process can be sustained. Consequently, any method that could potentially remove more biofilm and/or prevent its recurrence could improve the wound healing trajectory. Medaxis Debritom+™ cleans and stimulates acute and chronic wounds precisely in a tissue-preserving manner. Its high-pressure micro fluid jet removes slough such as fibrin, necrosis or biofilm, as well as foreign bodies, in effect providing an efficient irrigation and debridement of contaminated wounds. The purpose of this clinical investigation is to assess performance of Medaxis Debritom+™ and to collect subject outcome data in the treatment of diabetic foot ulcers (DFU) vs Standard sharp debridement. There are two arms in the study: Arm 1: The Experimental Arm , that will include SOC Therapy. SOC therapy in this study is offloading of the DFU (CAM boots or total contact casting \[TCC\] if the subject's foot is too large for a CAM), use of the Medaxis Debritom+™ micro jet to clean the wound followed by a wound care covering ( Fibracol dressing or equivalent) along with a moisture retention dressing and a padded 3-layer dressing comprised of 4x4 gauze pads, soft roll and compression wrap (DynaflexTM or equivalent). Arm 2: The Standard of Care Arm. The SOC therapy in this study is offloading of the DFU (CAM boots or total contact casting \[TCC\] if the subject's foot is too large for a CAM), appropriate sharp or surgical debridement, followed by a wound care covering (Fibracol dressing or equivalent) along with a moisture retention dressing and a padded 3-layer dressing comprised of 4x4 gauze pads, soft roll and compression wrap (DynaflexTM or equivalent).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
222
Advanced micro fluid jet therapy to clean and stimulate wound
Scalpel or Curette to clean and debride wound
Application of moisture retentive dressing, and a multi layer compression dressing
CCR Research
San Francisco, California, United States
Doctors Research Network
South Miami, Florida, United States
Foot and Ankle Associates of the Mid-Atlantic
Frederick, Maryland, United States
Foot and Ankle Associates of the Mid-Atlantic
Raleigh, North Carolina, United States
Proportion of wounds completely healed at or before 16 weeks
examine the time it takes the wound to heal over a 16 week period
Time frame: 16 weeks
Incidence of any index wound-related cellulitis or infection by 16 weeks
examine the number of subject that develop wound cellulitis or infection over 16 weeks
Time frame: 16 weeks
Cost of treatment, including any index wound-related complications, by 16 weeks
examine the cost of all treatments within 16 weeks
Time frame: 16 weeks
Percent Area Reduction at 16 weeks.
examine the reduction in wound size at 16 weeks
Time frame: 16 weeks
Cost of hospitalization for any index wound-related event, including any wound recurrence involving the area of the index wound by 16 weeks
examine the patient hospitalization costs for wound related event over 16 weeks
Time frame: 16 weeks
Incidence of hospitalization between randomization and EOS for any index wound-related event, including any wound recurrence involving the area of the index wound
examine the incidence of subject being hospitalized during the study period
Time frame: 16 weeks
Moleculight imaging
Difference in wound bioburden from wound biopsy
Time frame: 2 weeks
Kent Imaging - Snapshot camera
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Patient will be offloaded in a diabetic camboot after treatment, or total contact cast if patient cannot be fit with diabetic offloading boot
Application of a collagen alginate dressing
Lower Extremity Institute for Research and Therapy, LLC
Youngstown, Ohio, United States
Foot and Ankle Associates of the Mid-Atlantic
Salem, Virginia, United States
test oxygenation of wound tissue
Time frame: 16 weeks