ActiV.A.C.+ Compression Therapy Versus Compression Therapy Alone for the Treatment of Chronic Venous Ulcerations

This study has been terminated.
(slow recruitment - unable to meet enrollment goals)
Sponsor:
Information provided by (Responsible Party):
Christopher Attinger, M.D., Georgetown University
ClinicalTrials.gov Identifier:
NCT01528293
First received: January 27, 2012
Last updated: October 21, 2013
Last verified: October 2013
  Purpose

This is a prospective, randomized, comparative interventional human subject trial. Patients with a chronic venous ulceration of the lower extremity will be enrolled into this study. These wounds must be recalcitrant to the standard treatment regimen. There are a total of two arms in this study. One group will be randomly assigned to the Acti VAC + Compression therapy group consisting of the application of this device along with compression therapy. The other group will be randomly assigned into compression therapy only group. A total of 60 subjects will be enrolled into this 6 week study. There will be a 2 week run-in period (prior to the onset of the intervention) to ensure that the wound has not healed greater than 35% prior to intervention and randomization. Wounds that heal within the 6 week trial period will have an additional confirmatory visit 2 weeks after healing was identified.

If within the 6 week intervention period the wound bed is determined to be ready for a Split Thickness Skin Graft (STSG) or Bio-engineered Alternative Tissue (BAT), the surgery or clinic application will be scheduled within 4 weeks. Subjects deemed not to be a surgical candidate, will have Bio-engineered Alternative Tissue (BAT) application in the clinic. This includes patients who are medically unstable to receive a medical clearance for surgery or otherwise not a candidate for Split Thickness Skin Graft (STSG) surgery (e.g. donor site skin is compromised). During this period between the scheduled STSG surgery or BAT application, the subjects will continue within the assigned treatment group. A confirmatory visit will also occur 2 weeks after the application of a Split Thickness Skin Graft (STSG) or Bio-engineered Alternative Tissue (BAT).

Patients diagnosed with a chronic venous ulceration will be assessed for study eligibility during their initial clinical evaluation. Patients who meet the eligibility requirements will be asked to enroll into the study (see Subject Recruitment). Subjects will be asked to sign the informed consent form and receive a copy of the informed consent.


Condition Intervention
Chronic Venous Hypertension With Ulcer
Device: ActiVAC System + Compression therapy

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Prospective, Randomized, Comparative Effectiveness Trial of the ActiV.A.C.+ Compression Therapy Versus Compression Therapy Alone for the Treatment of Chronic Venous Ulcerations

Resource links provided by NLM:


Further study details as provided by Georgetown University:

Primary Outcome Measures:
  • Compare wound healing [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
    Wound healing between the ActiV.A.C. System + Compression therapy versus Compression therapy alone in patients with chronic venous ulcerations.


Secondary Outcome Measures:
  • Compare the time to wound bed preparation, quality of life, degree of Split Thickness Skin Graft/Bio-engineered Alternative Tissue take [ Time Frame: 9 weeks ] [ Designated as safety issue: No ]
    -Compare the time to wound bed preparation between the ActiV.A.C. System + Compression therapy versus Compression therapy alone in patients with chronic venous ulcerations.

  • Quality of Life [ Time Frame: 9 weeks ] [ Designated as safety issue: No ]
    Quality of life between ActiV.A.C. System + Compression therapy versus Compression therapy alone in patients with chronic venous ulcerations.

  • Degree of take [ Time Frame: 6 Weeks ] [ Designated as safety issue: No ]
    Degree of split thickness skin graft taken or bioengineered alternative tissue induced wound shrinkage after 6 weeks of ActiV.A.C. System + Compression therapy versus Compression therapy alone in patients with chronic venous ulcerations.


Enrollment: 3
Study Start Date: July 2012
Estimated Study Completion Date: July 2014
Estimated Primary Completion Date: July 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: ActiVAC System+ Compression therapy
ActiVAC System + Compression therapy group consisting of the application of this device along with compression therapy.
Device: ActiVAC System + Compression therapy

The ActiV.A.C. System will be applied in a customary manner per manufacturer's recommendations. Acticoat Flex 7™ will be applied as contact layer on the wound surface. Open cell foam is then applied over the top of the Acticoat Flex 7™. Adherent transparent occlusive material will be applied over the open cell foam. The tubing is then attached after cutting a small aperture through the occlusive material. Negative pressure will be set at 125mmHg on continuous suction. Sponge and canister will be replaced 2 time a week.

Compression Therapy Profore™ multi-layered compression bandaging system will be utilized. This includes the application of a contact layer dressing using Acticoat Flex 7™. The compression bandage will be applied per manufacturer's recommendations.

Other Name: ActiV.A.C System
compression therapy only
Standard of Care compression therapy only
Device: ActiVAC System + Compression therapy

The ActiV.A.C. System will be applied in a customary manner per manufacturer's recommendations. Acticoat Flex 7™ will be applied as contact layer on the wound surface. Open cell foam is then applied over the top of the Acticoat Flex 7™. Adherent transparent occlusive material will be applied over the open cell foam. The tubing is then attached after cutting a small aperture through the occlusive material. Negative pressure will be set at 125mmHg on continuous suction. Sponge and canister will be replaced 2 time a week.

Compression Therapy Profore™ multi-layered compression bandaging system will be utilized. This includes the application of a contact layer dressing using Acticoat Flex 7™. The compression bandage will be applied per manufacturer's recommendations.

Other Name: ActiV.A.C System

  Hide Detailed Description

Detailed Description:

Patients diagnosed with a chronic venous ulceration will be assessed for study eligibility during their initial clinical evaluation. Patients who meet the eligibility requirements will be asked to enroll into the study (see Subject Recruitment). Subjects will be asked to sign the informed consent form and receive a copy of the informed consent. The study will be conducted in the following manner:

Prescreening, Screening, and Enrollment

  • Obtain informed consent
  • Assess patients for eligibility based on inclusion/exclusion criteria
  • Initial quality of life questionnaire completed
  • Target ulcer

    • If more than 1 wound is present on either leg; the target ulcer will be the one that is the largest in overall dimensions. All other ulcers will be treated per Standard of Care.

  • Photo/wound measurements
  • Venous studies (if necessary to confirm diagnosis)
  • Case Record Form (CRF) completed
  • Subjects will continue with Standard of Care until treatment initiation visit

    • If a patient is currently undergoing pump or pneumatic compression therapy, they must discontinue this treatment at least 2 week before the treatment initiation visit

Treatment Initiation Visit and Randomization

  • Begin 2 weeks after the above enrollment visit - Confirm continued eligibility:

    • Photo/wound measurements (to be performed before and after debridement)
    • Exclude if wound size has decreased > 35% - Randomization into the 2 treatment groups

      1. ActiV.A.C. System Negative Pressure Therapy + Compression Therapy
      2. Compression Therapy - Quality of life questionnaires completed

        - CRF completed Subjects will have 1 visit in the clinic and 1 visit by a home nurse to change the dressing and Acti V.A.C ( if applicable) weekly

        Weekly Follow-Up

  • Visits must be ± 2 days of scheduled appointment

    • Photo/wound measurements (to be performed before and after debridement)
    • Change ActiV.A.C. System+ Compression Therapy or Compression Therapy
    • Quality of life questionnaires to be completed at weeks 4, 6
    • CRF completed
    • If the subject is has not healed or healed, and the wound is not ready for a Split Thickness Skin Graft (STSG) or Bio-engineered Alternative Tissue (BAT)at the 6 week time point, then the patient will be exited from the study (see Close-Out)
    • If the subject has not healed within the 6 week interventional phase, but the wound is ready for a Split Thickness Skin Graft or Bio-engineered Alternative Tissue (BAT), they will be scheduled for a Split Thickness Skin Graft (STSG) or Bio-engineered Alternative Tissue (BAT)

Close-Out

  • If the subject has not healed, they will be exited from the study at the 6 week time point
  • Photo/wound measurements (to be performed before and after debridement)
  • Close-out specific CRF completed
  • Complete quality of life questionnaires
  • Follow-up treatment plan with individual investigator

Confirmatory Visit

  • If the target wound has healed within the 6 week interventional period, the subject will be scheduled for this confirmatory visit 2 weeks after wound has been deemed to be healed
  • Photo/wound measurements (to be performed before and after debridement)
  • Close-out specific CRF completed
  • Complete quality of life questionnaires
  • Follow-up treatment plan with individual investigator

Split Thickness Skin Graft (STSG) or Bio-engineered Alternative Tissue (BAT)- If the wound is deemed ready for Split Thickness Skin Graft (STSG) or Bio-engineered Alternative Tissue (BAT) then the subject will either:

  • Be scheduled for surgery for application of a Split Thickness Skin Graft within 4 weeks
  • Have Bio-engineered Alternative Tissue (BAT)applied in the clinic within 4 weeks

    • Subject will continue with their intervention until the date of surgery
    • After Split Thickness Skin Graft, subjects will receive SOC utilizing the ActiV.A.C. ™ + Compression Therapy
    • After Bio-engineered Alternative Tissue (BAT), subjects will receive Standard of Care utilizing compression therapy
    • Photo/Wound Measurements (to be performed before and after debridement)
    • CRF completed
    • Subjects will have a f/u visit within 5-7 days for dressing change per Standard of Care

Close-Out/Confirmatory Visit for Split Thickness Skin Graft (STSG) or Bio-engineered Alternative Tissue (BAT)

*2 weeks from the date of surgery (Split Thickness Skin Graft) or clinic application (Bio-engineered Alternative Tissue)

  • Regardless if the target wound is healed or not, the subject will be exited from the study
  • Photo/Wound measurements
  • Percent adherence for subjects who received a Split Thickness Skin Graft
  • Close-out specific CRF completed
  • Complete quality of life questionnaires
  • Follow-up treatment plan with individual investigator

Application of Devices/Dressing

The usual consent forms that are part of the Standard of Care will be utilized per the Center for Wound Healing at Georgetown University Hospital. All costs associated with the clinic visit consistent with the Standard of Care will be billed in the customary fashion.

Standard of Care Wound Therapy (Debridement, Infection Control)

The surface of the venous wound will be washed and rinsed with a wound cleanser at every visit per Standard of Care. The need for debridement (utilizing a scalpel and/or curette) will be dependent of the amount of nonviable tissue and/or biofilm detected on the surface of the wound. The decision to debride will be made by the individual investigator at each visit. The use of topical enzymatic debriding agents will be at the discretion of the investigator. Further, the investigator may use topical antimicrobials as needed. The use of oral antibiotics will also be at the discretion of the individual investigator. No other wound healing modalities including topically applied treatments will be allowed.

ActiV.A.C.® Therapy System

The ActiV.A.C.® Therapy System is an FDA approved device for the treatment of venous ulcerations. The ActiV.A.C.® System will be applied in a customary manner per manufacturer's recommendations. Acticoat Flex 7™ will be applied as the contact layer on the wound surface. Acticoat Flex 7™ is a fenestrated, silver-coated (anti-microbial), knitted polyester material that is routinely used as a contact layer dressing for chronic wounds. The open cell foam is then applied over the top of the Acticoat Flex 7™ (cut to shape of the wound). The adherent transparent occlusive material will be applied over the open cell foam. The tubing is then attached after cutting a small aperture through the occlusive material. Negative pressure will be set at 125mmHg on continuous suction. The sponge and canister will be replaced 2 times per week. This dressing change will take place once in the clinic and once by the visiting home nurses. These nurses have had in-service training on the proper application of negative pressure therapy and have experience with its use.

Compression Therapy

Profore™ multi-layered compression bandaging system will be utilized. This includes the application of a contact layer dressing using Acticoat Flex 7™. The compression bandage will be applied per manufacturer's recommendations. The dressings will be changed 2 times per week. This dressing change will take place once in the clinic and once by the visiting home nurses. These nurses have had in-service training on the proper application of the compressive dressing and have experience with its use.

Standard of Care Post Split-Thickness Skin Graft or Application of a Bio-engineered Alternative Tissue (BAT)-

The application of a Split Thickness Skin Graft (STSG) or Bio-engineered Alternative Tissue (BAT) will follow the Standard of Care. This Standard of Care applies to both interventional groups. Split Thickness Skin Grafts will be applied in the operating room after debridement of the venous wound which will be conducted per Standard Of Care. After the placement of the Split Thickness Skin Graft onto the wound surface, a nonadherent dressing is placed onto the graft followed by a silver impregnated dressing layer. The ActiV.A.C.™ open celled foam will then be placed over the silver impregnated dressing in the customary fashion. Compressive dressing will then be placed over the ActiV.A.C.™ occlusive material. The postoperative dressings will be removed within 5-7 days. The wound site will then be redressed with a nonadherent dressing as the contact layer, silver impregnated dressing, and Profore™. The application of a BAT will take place in the outpatient clinic. This includes the debridement of the wound and the application of a Bio-engineered Alternative Tissue (BAT) onto the wound surface. The dressings include a nonadherent contact layer, followed by a silver impregnated dressing, and finally a Profore™ compressive dressing.

  Eligibility

Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Subjects between 18-75 years of age
  2. Subject able and willing to comply with study protocol requirements and able to understand the informed consent
  3. Non-pregnant female willing to take urine pregnancy test
  4. Chronic venous ulceration of the lower extremity

    • Defined: wound of greater than 1 month in duration
    • Diagnosis based on clinical assessment and/or venous studies
    • <100 cm2 area and <10cm at the widest diameter

Exclusion Criteria:

  1. Active infection (redness, swelling, pain, purulence)
  2. Untreated osteomyelitis or current osteomyelitis
  3. Allergy or sensitivity to wound study products
  4. Malignancy
  5. Plantar surface wounds
  6. BMI (Body Mass Index) ≥50
  7. Uncontrolled diabetes (HbA1c>12%) at the time of study screening
  8. End stage renal disease
  9. Undergoing chemotherapy/radiation therapy
  10. Non-dopplerable pedal pulses or otherwise diagnosed with peripheral arterial disease or any contraindication to compression therapy
  11. Any previous wound care therapy including negative pressure therapy, ultrasound therapy, BAT, or STSG within the previous 30 days of enrollment; this excludes compression therapy
  12. Greater than 35% wound surface area reduction in size at 2 weeks after initial screening visit
  13. Pregnancy
  14. Subject has any condition that, in the opinion of the investigator, makes the subject inappropriate to take part in this study
  15. Subject unwilling or unable to comply with protocol requirements
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01528293

Locations
United States, District of Columbia
Georgetown University Hospital, Center for Wound Healing
Washington, District of Columbia, United States, 20007
Sponsors and Collaborators
Georgetown University
Investigators
Principal Investigator: Christopher Attinger, M.D Georgetown University Hospital
Study Director: Paul Kim, DPM Georgetown University Hospital
  More Information

No publications provided

Responsible Party: Christopher Attinger, M.D., Director, Wound Healing Clinic, Georgetown University
ClinicalTrials.gov Identifier: NCT01528293     History of Changes
Other Study ID Numbers: ActiVac
Study First Received: January 27, 2012
Last Updated: October 21, 2013
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Hypertension
Ulcer
Varicose Ulcer
Vascular Diseases
Cardiovascular Diseases
Pathologic Processes
Varicose Veins
Leg Ulcer
Skin Ulcer
Skin Diseases

ClinicalTrials.gov processed this record on April 17, 2014