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CompletedNCT03461783Updated Feb 27, 2019

Activated Carbon Interphase Effect on Biofilm and Total Bacterial Load

An interventional study of Zorflex Activated Carbon Dressing and Standard of Care in Wound Infection, sponsored by Brock Liden, DPM. Completed at 2 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2019-02-27.

Sponsored by Brock Liden, DPM · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Primary completion was Aug 2018, 8 years 3 months ago, and no results have been posted to the registry.
  • Registered 6 months after the study started (first participant enrolled Jun 2017, registered Jan 2018).

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Phase
Not applicable
Study type
Interventional
Enrollment
21
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-13

Among 85 studies in Wound Infection with a site in United States — 8 open to participants now, 9 under way, 2 of them phase 3. Wound Infection · United States.

Enrollment
62nd of 78
21 · median 123
Started
2017
with 2 others
No phase
35 of 85
2 open now
Registered
58th of 85
by date

Among the 85 studies in Wound Infection with a site in United States, this one is the 62nd largest by enrollment of the 78 interventional ones that give a count, is one of 3 that started in 2017, is one of 35 with no phase, and was the 58th registered.

Wound Infection

270 studies on the registry are indexed under Wound Infection; 33 are open to participants now.

Browse Wound Infection studies →

Open to participants now

8 of the 85 studies in Wound Infection with a site in United States are open now. Recruiting first, the newest first:

3 more — sign in →

All 8 open studies →

A study can be open while its sites in United States have not opened yet or have stopped. Only those recruiting at a site in United States →

Who these studies take

Of the 23 Wound Infection studies recruiting now, 17 (74%) set no upper age limit and 1 (4%) stops at 75 or younger; 2 take children under 18; 2 take healthy volunteers.

This study: 18 Years and older · all sexes · no healthy volunteers.

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02

Study summary

The purpose of this randomized, prospective study is to evaluate how this activated carbon dressing affects the total bacterial load and biofilm in a wound bed in wounds of the lower extremity and foot. We anticipate that the use of Zorflex® Activated Carbon Cloth dressing will maintain the bacterial burden in the wound bed below the level of critical colonization, with potential secondary benefits of pain reduction, decrease in inflammation, and control of odor. Wound bed healing progression/acceleration also will be assessed.

Read the detailed description

Wounds located on the lower extremity and feet are caused by several conditions, including diabetes and venous insufficiency. These types of wounds may not heal quickly and can become chronic. Chronic wounds are at risk for infection and limb amputation. As such, these wounds are a serious health issue, especially in diabetics and the elderly, and pose a significant public health burden. The healing of such wounds is an ongoing challenge to clinicians, who continue to seek effective management modalities.

The study treatment evaluated in this study is Zorflex® dressing (Chemviron Carbon Cloth Carbon, West Midlands, United Kingdom; a division of Calgon Carbon Corporation, Pittsburgh, PA). According to the Instructions for Use for the product, it is a low-adherent, 100% pure activated carbon cloth dressing that highly conforms to the body contours and maintains contact with the wound surface. It provides an effective antimicrobial barrier for a minimum of 7 days per dressing, protecting the wound from invasive microorganisms, while exhibiting an antimicrobial effect against microorganisms already present in the wound. The dressing may be used either dry or moistened with sterilized water. Zorflex® is indicated as an antimicrobial dressing over dry or discharing, partial and full thickness wounds.

The following unique properties of the activated carbon dressing are believed to aid in wound healing and patient comfort when used for wound management: 1) antimicrobial; 2) odor management; and 3) conductive. The dressing is antimicrobial and manages odor because of its naturally occurring "van der Waal's" electrostatic forces. These forces draw small gas or liquid molecules, including endotoxins and odor molecules, away from the wound into the highly structured micropores of the dressing, where they become trapped. Bacteria cells also are attracted to the dressing, but are too big to enter the micropores. Instead, the microorganisms become trapped on the surface, away from the wound bed. Electrostatic tension builds up in the trapped microorganisms until the tension overcomes the tensile strength of the cell walls, at which time the cell walls of the microorganisms rupture, killing the microorganisms. Any endotoxins released in the process are drawn into the micropores and also become trapped. The conductive nature of the dressing restores the body's natural transepithelial potential across the wound bed, thereby aiding in healing. The positive effects of electrostimulation on wound healing have been previously established.

Several studies, primarily case series, have reported promising preliminary results with the use of Zorflex® as an antimicrobial dressing for wound management. In a case series involving four patients with recalcitrant venous leg ulcers that were prone to recurrent infection, treatment with this particular activated carbon cloth dressing resulted in a reduction in clinical signs of infection, such as exudate and pain levels, and improvement in wound bed appearance after 7 days. A retrospective study evaluating the use of this activated carbon cloth dressing for the management of 18 chronic wounds demonstrated 90.7% wound closure at 5 weeks. Finally, another case series examining the use of Zorflex® in chronic lower extremity and foot wounds demonstrated a reduction in odor control and progression of healing with the use of the dressing.

Studies examining the efficacy of such activated carbon dressings are limited and, therefore, more research, particularly randomized and prospective in design, is needed to better elucidate possible effects of this dressing on preventing infection and promoting healing. The purpose of this multi-center, randomized, prospective study is to evaluate how this activated carbon dressing affects the total bacterial load and biofilm in a wound bed in wounds of the lower extremity and foot. We anticipate that the use of Zorflex® Activated Carbon Cloth dressing will maintain the bacterial burden in the wound bed below the level of critical colonization, with potential secondary benefits of pain reduction, decrease in inflammation, and control of odor. Wound bed healing progression/acceleration also will be assessed.

03

Conditions studied

  • Wound Infection

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04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Patients who are at least 18 years of age.
  • Patients of both genders and all races.
  • Patients who are in good general health.
  • Patients with ankle-brachial index (ABI) measurements greater than 0.5.
  • Patients with full-thickness lower extremity diabetic or venous wounds that are not currently being treated with antimicrobial products.
  • Patients with full-thickness wounds that are not yet extending to the bone or tendon.
  • Patients with wounds present for at least 4 weeks, but no longer than one year.
  • Patients with initial bacterial load greater than or equal to 104 colony forming units (CFUs), but less than or equal to 106 CFUs.
  • Patients who have voluntarily signed the form, including HIPAA Authorization.

Exclusion criteria

Exclusion Criteria:

  • Patients who are younger than 18 years of age.
  • Patients with conditions.
  • Patients with ABI measurements less than 0.5 or with lower extremities that are non-interventional or by-passable.
  • Patients with full-thickness lower extremity pressure wounds.
  • Patients with diabetic or venous wounds that are being treated with antimicrobial products.
  • Patients with full-thickness wounds with exposed bone or tendon.
  • Patients with wounds present less than 4 weeks or one year or longer.
  • Patients with ulcers that had an initial bacterial load less than 104 CFUs or greater than 106 CFUs.
  • Patients who are pregnant or lactating.
  • Patients with known allergy(ies) to any of the components of the study dressing.
  • Patients who are considered by the investigator for any reason to be an unsuitable candidate.
  • Patients who are unwilling or unable to follow the follow-up evaluation schedules.
  • Patients who refuse to voluntarily sign the form.
Terms in these criteria, in plain language(2)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
21 participants (actual)

Study arms

  • Experimental
    Zorflex Activated Carbon Dressing

    Patients randomized into the experimental group will only be treated using an activated carbon dressing (Zorflex® Activated Carbon Cloth Dressing; Chemviron Carbon Cloth Carbon, West Midlands, United Kingdom; a division of Calgon Carbon Corporation, Pittsburgh, PA) for wet wounds or with saline and Zorflex® Activated Carbon Cloth Dressing for dry wounds.

    Device: Zorflex Activated Carbon Dressing

  • Active comparator
    Standard of Care for Wound Care

    Patients with wet wounds randomized into the control group will be treated using foam, calcium alginate or compressive dressings, whereas those with dry wounds will be treated with hydrogel and compressive dressings.

    Device: Standard of Care

Interventions

  • DeviceZorflex Activated Carbon Dressing

    Antimicrobial dressing

  • DeviceStandard of Care

    foam, calcium alginate, hydrogel, or compressive dressings

06

What researchers measure

Primary outcomes

  1. Total Bacterial Load

    Total bacterial load will be measured total colony forming units (CFUs) as determined from laboratory findings

    Time frame: 4 weeks

Secondary outcomes

  1. Pain Associated with Wound

    Patients will rate their pain on a Visual Analog Scale (VAS) that consists of a 10cm (100mm) line with the descriptor "no pain" positioned at the left pole and the descriptor "worst pain imaginable" positioned at the right pole.

    Time frame: 4 weeks

  2. Wound Bed Inflammation

    Protease laboratory measurements of the wound bed will be use to elevate wound bed inflammation.

    Time frame: 4 weeks

  3. Wound Odor

    Wound odor will be assessed by both the patient and investigator using Visual Analog Scale (VAS) that consists of a 10cm (100mm) line with the descriptor "no odor" positioned at the left pole and the descriptor "extremely offensive odor" positioned at the right pole.

    Time frame: 4 weeks

  4. Wound Size Progression

    Wound size measurements obtained from the software utilized by the eKare inSight™ (eKare, Inc., Fairfax, VA) system will be used to determine wound bed healing progression.

    Time frame: 4 weeks

07

Study locations

2 sites
  • Circleville Foot & Ankle, LLC
    Circleville, Ohio 43113, United States
  • Hocking Valley Community Hospital
    Logan, Ohio 43138, United States
08

References and documents

Publications

  • Isseroff RR, Dahle SE. Electrical Stimulation Therapy and Wound Healing: Where Are We Now? Adv Wound Care (New Rochelle). 2012 Dec;1(6):238-243. doi: 10.1089/wound.2011.0351. PubMed 24527312 ↗
  • Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003 Sep;4(7):407-14. doi: 10.1016/s1526-5900(03)00716-8. PubMed 14622683 ↗
  • Kalinski CK, Schnepf M, Laboy D, Hernandez L, Nusbaum J, McGrinder B, Comfort C, Alvarez OM. Effectiveness of a Topical Formulation Containing Metronidazole for Wound Odor and Exudate Control. Wounds. 2005;17(4):84-90.
  • Miller MS, Markey L, Yoder R. A link to reducing the stink - use of a unique carbon based textile dressing Zorflex® to promote healing while significantly reducing wound odor in diabetic and venous ulcers - a case series of three. Presented as a poster at the Wild on Wounds (WOW) National Wound Conference, Las Vegas, NV, Aug 31-Sept 3, 2016.
  • Murphy N. Reducing infection in chronic leg ulcers with an activated carbon cloth dressing. Br J Nurs. 2016 Jun 23;25(12):S38-44. doi: 10.12968/bjon.2016.25.12.S38. PubMed 27345081 ↗
  • Young S, Gray S, and Hampton S. A retrospective study to evaluate the effect of an activated carbon dressing on chronic wounds. Presented as an e-poster at the 2016 European Wound Management Association (EWMA), Bremen, Germany, May 11-13, 2016.
  • Zorflex® Instructions for Use. http://zorflex.com/what-is-zorflex/, accessed on January 17, 2017.

Individual participant data

Plan to share: No — No plan to make individual participant data available to other researchers.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Jun 2017 to primary completion in Aug 2018, 13 months.

Of 59 non-industry interventional studies with no phase under Wound Infection, half reached primary completion within 19 months of starting (the median), counting those still running; a quarter within 13 and three quarters within 53. This study's 13 months is below that.

Counting every sponsor, half of 64 studies reached it within 19 months; a quarter within 13 and three quarters within 53.

How these figures are worked out, and which studies are left out of them.

Registered
Jan 11, 2018
First posted
Mar 12, 2018
StartActual
Jun 26, 2017
Primary completionActual
Aug 3, 2018
CompletionActual
Feb 1, 2019
Last update
Feb 27, 2019
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Feb 27, 2019, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03461783
Lead sponsor
Brock Liden, DPM
Responsible party
Brock Liden, DPM (Principal Invesigator, Liden, Brock, DPM) — Sponsor-investigator
First posted
Mar 12, 2018
Start date
Jun 26, 2017
Primary completion
Aug 3, 2018
Completion
Feb 1, 2019
Last update
Feb 27, 2019

Study contacts

Brock Liden, DPM
principal investigator · Circleville Foot & Ankle LLC

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Feb 2019. You cannot join it, but the record below documents what was studied.

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