Modified Platform Trial Assessing Multiple Umbilical Cord-based CAMPs and SOC v SOC Alone in the Treatment of Hard-to-Heal VLUs

1. At least 18 years of age or older.
2. Has a medical diagnosis of venous insufficiency with an open wound to the lower extremity.
3. At enrollment, target ulcer with a minimum surface area of 1.0 cm2 and a maximum surface area of 15.0 cm2 measured post debridement with the MolecuLight® Imaging Device.
4. The target ulcer must have been present for a minimum of 4 weeks and a maximum of 52 weeks of standard of care, prior to the initial screening visit.
5. The target ulcer must be full thickness on the foot or leg without exposed bone.

6. The affected limb must have adequate perfusion confirmed by vascular assessment. Any of the following methods performed within 3 months of the first screening visit are acceptable:

   1. ABI between 0.7 and ≤ 1.3;
   2. TBI ≥ 0.6;
   3. TCOM ≥ 30 mmHg;
   4. PVR: biphasic.
7. If the potential subject has two or more ulcers, they must be separated by at least 2 cm. The largest ulcer satisfying the inclusion and exclusion criteria will be designated as the target ulcer.
8. Target ulcers must be treated with compression therapy for at least 14 days prior to enrollment.
9. The potential subject must consent to using the prescribed compression therapy for the duration of the study.
10. The potential subject must agree to attend the weekly study visits required by the protocol.
11. The potential subject must be willing and able to participate in the informed consent process.

Exclusion Criteria:

1. The potential subject is known to have a life expectancy of \< 6 months.
2. The target ulcer is infected or there is cellulitis in the surrounding skin.
3. There is evidence of osteomyelitis or exposed bone, probes to the bone or joint capsule.
4. There is an infection in the target ulcer or in a remote location that requires systemic antibiotic therapy.
5. The potential subject is receiving immunosuppressants (including systemic corticosteroids at doses greater than 10 mg of prednisone per day or equivalent) or cytotoxic chemotherapy or is taking medications that the PI believes will interfere with wound healing (e.g., biologics).
6. The potential subject is taking hydroxyurea.
7. The potential subject has applied topical steroids to the ulcer surface within one month of initial screening.
8. The potential subject with a previous partial amputation on the affected foot that results in a deformity that impedes proper treatment of the target ulcer.
9. If the subject is diabetic and has a glycated hemoglobin (HbA1c) greater than or equal to 12% within 3 months of the initial screening visit.
10. The surface area of the target ulcer has reduced in size by more than 25% in the 2 weeks prior to the initial screening visit ("historical" run-in period) or the 2 weeks from the initial screening visit (SV1) to the TV1/randomization visit during which time the subject received SOC. MolecuLight Imaging Device is not required for measurements taken during the historical run-in period (e.g., calculating surface area using length X width is acceptable).
11. Women who are pregnant or considering becoming pregnant within the next 6 months.
12. The potential subject has end stage renal disease requiring dialysis.
13. Participation in a clinical trial involving treatment with an investigational product within the previous 30 days.
14. A potential subject who, in the opinion of the investigator, has a medical or psychological condition that may interfere with study assessments.
15. The target ulcer was treated with hyperbaric oxygen therapy (HBOT) or a Cellular, Acellular, Matrix-like Product (CAMP) in the 30 days prior to the initial screening visit.
16. The potential subject has a malnutrition indicator score \<17 as measured on the Mini Nutrition Assessment.