MIRODERM H2H DFU Study

The primary objective of this study is to determine the number of successful complete wound
closures within 12 weeks of treatment with MIRODERM Fenestrated Biological Wound Matrix. Some
secondary objectives of this study include documenting the time course of wound healing and
assessing changes in quality of life.

The primary cohort is individuals suffering from a diabetic foot ulcer that has not been
healed in the last 3 months and after at least 2 attempts with an advanced biologic. Ulcer
will be between 1 and 12 cm squared, less than 5 mm deep, full thickness, below the ankle,
and with no exposed bone or tendon. Subjects will be 18 or older, have Type I or II diabetes
with adequate vascular profusion. Subjects will be unable to participate if they have
osteomyelitis, Charcot foot, a known collagen vascular disease, are on dialyses, are
immunocompromised or have an HbA1c level equal to or great than 12%.

This is a single-arm study with no Independent Variables. Descriptive data to be collected
will include demographics, pathology and medical history.

Outcome assessments:

- proportion of subjects with 100% epithelialization of wound

- SF-36

- Adverse events

Inclusion Criteria:

- 18 years old or older at time of initial visit

- Have Type I or Type II diabetes

- Have a neuropathic diabetic foot ulcer with the following characteristics:

- Is greater than 1 cm2 and less than or equal to 12 cm2

- Has failed to close following at least 2 treatments with a biologic

- Has been present for 90 days or longer

- Does not show signs of infection

- Is full thickness (Wagner Grade I or II)

- Located distal to the malleolus

- Depth of less than or equal to 5 mm

- No exposed capsule, tendon or bone

- No tunneling, undermining or sinus tracts

- Not between the toes

- Be willing and able to maintain required off-loading of affected limb

- Be willing and able to perform necessary dressing changes

- Have at least one of the following:

- An Ankle-brachial index (ABI) ≥ 0.8

- TcPO2 of ≥ 30 mmHg

- A toe pressure of ≥ 50 mmHg

Exclusion Criteria:

- Be pregnant or be planning to become pregnant during the study

- Have had a Chopart's Amputation (or higher)

- Have a history of bone cancer of the affected limb

- Be undergoing dialysis

- Have active osteomyelitis or be receiving treatment for osteomyelitis

- Be diagnosed with unstable Charcot Foot on the affected side

- Have an HbA1c level of ≥ 12% within the past 90 days

- Have another ulcer within 2 cm of the study ulcer

- Be immunocompromised or at risk of immunosuppression as determined by the treating
investigator

- Have a known collagen vascular disease or connective tissue disease

- Have received treatment of the study ulcer with a skin substitute product or topical
growth factor within the past 4 weeks

- Be participating in another medical research study

- Have a sensitivity to porcine material