Windowed CastsEvaluation of Windowed Casts With and Without Regranex® Gel for Healing Diabetic Neuropathic Ulcers

Inclusion Criteria:

• Subject must sign an informed consent
• Have a history of compliance and reliability in following study required treatment regimen.
• Have diabetic mellitus Type I or Type II and have a glycohemoglobin Alc less than l0
• Presence of one or two ulcers in lower extremities

1. Wounds cannot be positioned more than 2.5cm proximal to the malleoli, but may involve any more distal position of the foot
2. Type 2 Diabetic Mellitus Neuropathic ulcers present at least for 3months with failure to heal
3. Post-operation wounds in DM patients with wound present for minimum 4 weeks after surgery and wound surface area has failed to decrease more than 20% in 4 weeks
4. Ulcer(s) must be stage II or III full-thickness (extending through the subcutaneous tissue or beyond - Wagner grade II or III)
5. No joint, tendon or bone exposure
6. Located on the lower extremity.
7. Ulcer size measures 1cm2 < 16 cm2
8. No osteomyelitis affecting the area of the ulcer
9. If two wounds, both can be incorporated into one window when cast applied

• Adequate foot arterial circulation evidenced by palpable ankle pulses or Doppler with ABI less than or equal to 0.8. If non-compressible, must have triphasic wave Doppler velocity waveforms or toe/brachial pressure greater than or equal to 0.6.

Exclusion criteria:

• Female subjects who are within child bearing age range.
• Previous sensitivity to Regranex® Gel.
• Use of topical antibiotics, enzymatic debriders on the selected ulcer(s) within 30 days preceding randomization.
• Osteomyelitis affecting the area of the selected ulcer(s)
• Exposed bone, joint or tendon at ulcer site (Wagner III or higher)
• Presence of more than two full-thickness ulcers on targeted lower extremity
• Requirement for systemic antibiotics use within 7 days of study entry
• Inability to tolerate cast
• Presence of systemic or local cancer of any kind
• Life expectancy less than 1 year
• Subjects with end stage renal failure requiring chronic hemodialysis
• Concomitant use of Pletal or other vasodilators
• Ankle Brachial Index less or equal to 0.8 or toe pressure index less than 0.6
• ESR>20
• Demonstration of poor compliance including a chronic alcohol, psychiatric condition or drug abuse problems