Study to Assess the Safety of DERMASEAL for Diabetic Foot Ulcers

Inclusion Criteria:

1. Men or women ≥ 21 years of age.

2. The subject is able and willing to adhere to study procedures and informed consentis obtained.

3. A non-healing ulcer that is diabetic and neuropathic in origin, located on the footas defined by beginning >50% below the malleoli of the ankle.

4. Target ulcer surface area between 1 - 10 cm2 after debridement with no activeinfection.

5. Patients with Type 1 or Type 2 diabetes (criteria for the diagnosis of diabetesmellitus per American Diabetes Association.)

6. Additional wounds may be present but not within 2 cm of the target ulcer.

7. Patient has adequate arterial perfusion of the affected extremity as demonstrated byany one of the following within the past 90 days from the time of screening: i. Toe pressure (plethysmography) >50 mm/Hg OR ii. Ankle Brachial Index (ABI) withresults ≥ 0.70 and ≤ 1.2 OR iii. TcpO2 ≥30 mm Hg from the foot OR iv. Dopplerarterial waveforms consistent with adequate flow in the foot (biphasic or triphasicwaveforms at the ankle of affected leg)

8. Target ulcer involves a full thickness skin loss, WITHOUT exposure of tendon,muscle, or bone (University of Texas Grade 1-A or Wagner Grade 1) that has beenpresent ≥ 4 weeks. at the time of screening.

9. HbA1c <10% taken within 30 days prior to Visit 3.

10. Serum creatinine <3.0 mg/dl within the last 6 months.

11. Willing and able (subject or responsible caregiver) to maintain required off-loading (as applicable for the location of the ulcer).

12. Negative urine pregnancy test at Visit 3 for women of childbearing potential. i)Women participants are considered of non-childbearing potential if they arepre-menopausal with a documented hysterectomy or bilateral oophorectomy; orpost-menopausal defined as the cessation of regular menses for at least 12consecutive months with no alternative pathological or physiological cause; or havea serum Follicle Stimulating Hormone level confirming the post-menopausal state.

Exclusion Criteria:

1. Suspected or confirmed signs/symptoms of wound infection (subjects may be rescreenedif the infection has been treated.) Infection is defined as, for example: i. purulence, erythema, cellulitis, excessively high temperatures in/around theulcer, atypical smell, and/or excessive pain in/around the ulcer (infection may betreated and subject reconsidered for study participation). ii. osteomyelitis, with necrotic soft bone. (x-ray to be obtained if in the opinionof the investigator additional confirmation of diagnosis required)

2. Patients presenting with an ulcer probing to tendon, capsule or bone (University ofTexas Grade 2 or 3 or deep Wagner 2 or 3).

3. Hypersensitivity to silver or fresh frozen plasma.

4. The subject was previously entered into this study or had participated in any studydrug or medical device study within 30 days of screening.

5. Currently on a treatment regimen or medications which in the opinion of theinvestigator are known to interfere with wound healing (for example: cancerchemotherapy or equivalent immunosuppressants, systemic steroids > 10 days oftreatment, cytostatic drugs, cyclooxygenase-2 inhibitors, or radiation therapy).

6. Excessive lymphedema that in the opinion of the investigator will interfere withwound healing.

7. A cognitive, physical, or psychological condition interfering with subject's abilityto comply with the treatment regimen.

8. Active Charcot foot or unstable Charcot that in the opinion of the investigator willinhibit wound healing.

9. Wounds secondary to vasculitis, neoplasms, or hematological disorders. Patients onanticoagulation medication will as in any surgical procedure, be monitored accordingto the protocols employed at the enrolling center.

10. An ulcer that in the opinion of the investigator is not associated with thesubject's diabetic neuropathic condition.

11. Subjects is on dialysis.

12. History of radiation to the target foot.

13. Patients with uncontrolled autoimmune connective tissue diseases.

14. Patients who are pregnant, breast feeding, or unwilling to practice contraceptivemethods during participation in the study, if applicable. Effective methods ofcontraception include: i. oral, injectable, or implanted hormonal contraceptives ii. intrauterine device orsystem, iii. barrier method with spermicide, or iv. bilateral tubal occlusion.

15. Patients with uncontrolled anemia (Hgb<10 g/dL in women; <12 g/dL in men) atScreening.

16. Severe malnutrition (serum albumin ≤2.0 with a normal C-reactive protein).

17. Wounds healed by >30% in area following the 2-week, active run-in period as measuredduring Visit 3.

18. Use of hyperbaric oxygen, and active dressings that include growth factors,engineered tissues, or skin substitutes (e.g., Regranex, Dermagraft, Apligraf, etc.)within 30 days of study screening.

19. Wounds >5 mm deep after sharp debridement.

20. Clinical suspicion of skin cancer at or near the ulcer location which has not beenruled out by biopsy.