Decellularised Dermis Allograft for the Treatment of Chronic Venous Leg Ulceration

NCT ID: NCT04021316

Last Updated: 2023-09-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

71 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-01

Study Completion Date

2023-04-10

Brief Summary

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Does the use of decellularised dermis allograft in addition to compression therapy promote healing in chronic venous leg ulceration compared to compression therapy alone

Detailed Description

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Chronic venous ulceration are open wounds on the lower limbs which have been present for at least three months and are caused by a poorly functioning venous system. The affect about 1% of the general population and about 4% of those over 65. The wounds cause pain, reduced movement, and can smell - greatly affecting the quality of life of leg ulcer patients. The standard care for these patients is compression bandaging, which requires changing several times a week by community or district nurses; this drives the high cost of leg ulcer care, which can amount to £2.5 billion per annum.

Skin grafting can be used alongside compression bandaging and can help the ulcers heal faster than compression alone. Grafts can be taken from the patient's own skin, from a donor or from tissue engineered skin. An autograft (using own skin) can cause scarring and the need for a formal surgical procedure in theatre so are not suitable for all ulcer patients. Allografts (donor skin) and xenografts (animal skin) have been used successfully, but present similar drawbacks to autografts, plus the potential for the body to reject the graft and disease transmission. Tissue engineered skin has several advantages as it has been processed to remove the cells, and therefore is won't be rejected via the immune response. Human decellularised dermis (DCD) is generated from donated skin from deceased people and processed to remove the cells. It can be glued or sewn onto the skin under local anesthetic, in an out patient setting. DCD has mainly been studied in patients with diabetic foot ulceration and has shown improved healing rates and quality of life.

This study will investigate the use of DCD in addition to compression therapy versus compression therapy alone in patients with chronic venous leg ulceration.

Conditions

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Venous Ulcer Allograft

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will undergo 1:1 web based randomisation to either standard care or the intervention via an automated system. A minimization algorithm using centre, index ulcer size and duration will be used, including a random component to lessen predictability. A separate Randomisation System Description document will contain full details of the cut-offs for index ulcer size and duration, and the probability that the allocation will be switched.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

It is not possible to mask participants or the research/clinical teams to the treatment strategy as the DCD graft is visible after application for a period of time. However the primary outcome assessments (verification of index ulcer healing visits) will be completed by an independent clinical assessor trained in the assessment of wound healing, who will have no previous involvement with, or knowledge of, the participant's index ulcer treatment and as such will be blind to the randomised treatment strategy (as the DCD is not expected to be visible after 4 weeks).

Study Groups

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Standard care arm

Compression bandaging therapy as per standard care

Group Type ACTIVE_COMPARATOR

Compression bandaging therapy

Intervention Type OTHER

Compression therapy will be according to local practice and may include multilayer elastic compression bandaging or stockings delivering 20 to 40mm/Hg pressure.

DCD Arm

DCD graft plus compression bandaging therapy as per standard care

Group Type EXPERIMENTAL

dCELL® Human Dermis (decellularised dermal skin allograft - DCD)

Intervention Type OTHER

DCD is produced from split thickness skin grafts (which comprise the epidermis and upper part of the dermis), and is retrieved from deceased tissue donors. All epidermal and cellular components from the dermis are removed in a patented sequential decellularisation process. As a decellularised graft, dCELL® Human Dermis fully integrates into the wound bed after application, replacing lost dermal tissue. It provides a scaffold into which the recipient's cells can grow, becoming vascularised and supporting the generation of a new epidermis, ultimately regenerating into normal skin.

Compression bandaging therapy

Intervention Type OTHER

Compression therapy will be according to local practice and may include multilayer elastic compression bandaging or stockings delivering 20 to 40mm/Hg pressure.

Interventions

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dCELL® Human Dermis (decellularised dermal skin allograft - DCD)

DCD is produced from split thickness skin grafts (which comprise the epidermis and upper part of the dermis), and is retrieved from deceased tissue donors. All epidermal and cellular components from the dermis are removed in a patented sequential decellularisation process. As a decellularised graft, dCELL® Human Dermis fully integrates into the wound bed after application, replacing lost dermal tissue. It provides a scaffold into which the recipient's cells can grow, becoming vascularised and supporting the generation of a new epidermis, ultimately regenerating into normal skin.

Intervention Type OTHER

Compression bandaging therapy

Compression therapy will be according to local practice and may include multilayer elastic compression bandaging or stockings delivering 20 to 40mm/Hg pressure.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* ≥18 years or older (no upper age limit)
* The ability to consent to participation
* A diagnosis of venous leg ulceration\* (defined as 'colour duplex confirmation of superficial and or deep venous reflux with any break in the skin that has either: a) been present for more than 2 weeks, or b) occurred in a person with a history of venous leg ulceration)
* Documented venous incompetence on duplex ultrasound
* Index ulcer wound duration of greater than 3 months
* Index ulcer wound size ≥ 2 cm2.
* ABPI ≥ 0.8

* in light of the Covd-19 pandemic, the use of handheld continuous wave Dopplers will be allowed to diagnose venous disease to allow participants to be recruited from clinic without the need for an imaging appointment

Exclusion Criteria

* A diagnosis of sickle cell
* Unable to receive one or more of the randomised treatment strategies for any reason at the discretion of the attending clinical team (e.g. known allergies to dCELL dermis preparation components)
* A clinically infected ulcer defined as evidence of erythema, cellulitis or systemically unwell
* Treatment with biomedical/topical growth factors within previous 30 days
* Previous history of an inability to tolerate compression therapy
* Foot ulcer (i.e. below the ankle)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Edinburgh

OTHER

Sponsor Role collaborator

Universidad de Granada

OTHER

Sponsor Role collaborator

University of Manchester

OTHER

Sponsor Role collaborator

Gloucestershire Hospitals NHS Foundation Trust

OTHER

Sponsor Role collaborator

Cambridge University Hospitals NHS Foundation Trust

OTHER

Sponsor Role collaborator

University of Birmingham

OTHER

Sponsor Role collaborator

NHS Blood and Transplant

OTHER_GOV

Sponsor Role collaborator

Imperial College London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Alun H Davies

Role: PRINCIPAL_INVESTIGATOR

Imperial College London

Locations

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North Bristol NHS Trust

Bristol, , United Kingdom

Site Status

Cardiff and Vale University Health Board

Cardiff, , United Kingdom

Site Status

North Cumbria University Hospitals NHS Trust

Carlisle, , United Kingdom

Site Status

Gloucestershire Hospitals NHS Foundation Trust

Gloucester, , United Kingdom

Site Status

AT Medics

London, , United Kingdom

Site Status

Guy's and St Thomas' NHS Foundation Trust

London, , United Kingdom

Site Status

Imperial College Healthcare NHS Trust

London, , United Kingdom

Site Status

London North West University Healthcare

London, , United Kingdom

Site Status

St Charles Centre for Health and Welbeing, Central London Community Healthcare NHS Trust

London, , United Kingdom

Site Status

Aneurin Bevan University Health Board

Newport, , United Kingdom

Site Status

Northampton General Hospital NHS Trust

Northampton, , United Kingdom

Site Status

Livewell

Plymouth, , United Kingdom

Site Status

University Hospitals Plymouth NHS Trust

Plymouth, , United Kingdom

Site Status

Swansea Bay University Health Board

Swansea, , United Kingdom

Site Status

Taunton and Somerset NHS Foundation Trust

Taunton, , United Kingdom

Site Status

Mid Yorkshire Hospitals NHS Trust

Wakefield, , United Kingdom

Site Status

Worcestershire Acute Hospitals NHS Trust

Worcester, , United Kingdom

Site Status

Countries

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United Kingdom

Other Identifiers

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19CX5371

Identifier Type: -

Identifier Source: org_study_id

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