Piomic COMS_03

The purpose of this clinical trial is to evaluate the safety and effectiveness of the treatment with the COMS One device in subjects with refractory diabetic foot ulcers (DFUs). The prospective randomized, double-blinded, sham-controlled trial is designed to demonstrate superiority of wound closure of the COMS One device to a sham-control device at 12 weeks post-application, when each is administered in conjunction with standard of care (SOC) in the treatment of DFUs.

The purpose of this clinical trial is to evaluate the safety and effectiveness of the treatment with the COMS One device in subjects with refractory diabetic foot ulcers (DFUs). The prospective randomized, double-blinded, sham-controlled trial is designed to demonstrate superiority of wound closure of the COMS One device to a sham-control device at 12 weeks post-application, when each is administered in conjunction with standard of care (SOC) in the treatment of DFUs.

Primary Objective The COMS One Therapy System is intended to promote wound healing in chronic DFUs. As part of the clinical investigation, the primary objective is to determine complete wound healing at 12 weeks post-application of the device defined as complete skin re-epithelialization without drainage confirmed by 2 consecutive trial visits 2 weeks apart.

Secondary Objectives Secondary objectives are confirmation of safety and assessment of wound healing parameters as well as subject and site reported outcomes.

A total of 320 subjects with refractory DFU will be screened. It is expected that 30% of subjects will be excluded from the trial if either of the following occur between screening

And randomization: >30% wound closure over a period of 2 weeks or >50% wound closure over a period of 4 weeks (measured post-debridement). The remaining 224 subjects will be randomized into two groups (112 Subjects Sham device treated; 112 Subjects Coms One device treated).

Inclusion Criteria:

1. Subjects are male or female, ≥22 and ≤90 years of age

2. Female subjects of childbearing potential must be willing to use acceptable methods of contraception (birth control pills, barriers, or abstinence) starting at screening and throughout the duration of their study participation.

3. Able to understand and sign the informed consent form (ICF) and comply with requirements set in the protocol including trial visits, trial treatment and dressing regimens and compliance with required offloading device (if applicable)

4. Type 1 or Type 2 diabetes mellitus

5. Presence of one full-thickness DFU located at or below the malleoli (If the subject has more than one DFU that meets eligibility criteria, the investigator will designate one DFU as the target DFU to be treated in the trial)

6. Wagner Grade 1 or 2 (without bone exposure)

7. There is a minimum 2 cm margin between the target DFU and any other ulcer on that same foot, post-debridement

8. Target DFU duration >30 days and 0. 7 but less than 1. 2 or a toe-brachial index (TBI) >0.4 but less than 0.7 or a transcutaneous oxygen pressure (TcPO2) >40mmHg

Exclusion Criteria:

1. Known pregnancy or lactating

2. Active skin cancer, a history of skin cancer or any other localized cancer, precancerous lesions or large moles in the areas to be treated.

3. Subject who is taking any medications the Principal Investigator (PI) believes may interfere with healing of the target DFU

4. Subject who is currently undergoing treatment for an active systemic infection, including osteomyelitis

5. Wagner Grade 3, 4 or 5

6. Participation in another trial with investigational drug or device within the 30 days preceding and during the present trial

7. Any co-morbid medical condition which places the subject at unreasonable risks in the opinion of the investigator (such as history of HIV or a clinically significant cardiac, gastrointestinal, endocrine, neurological, liver, or kidney disease) of the investigator)

8. Subject has chronic renal insufficiency requiring dialysis (end stage renal disease)

9. Subject is being treated with systemic corticosteroids (prednisone, dexamethasone, hydrocortisone, methylprednisolone, or similar) >10mg/day for more than 10 days or any dose >30 days

10. For subjects in the 2-Week Run-In Phase: more than 30% closure of target DFU at

Screening Run-In Phase Visit I or Randomization/Baseline Visit or more than 50%

closure of target DFU between the 2 Week Historical Period and Randomization/Baseline

Visit (measured post-debridement)

1. For subjects in the 4-Week Run-In Phase: more than 30% closure of target DFU at

Screening Run-In Visit II or between Screening Run-In Phase Visit II and

Randomization/Baseline Visit or more than 50% closure of target DFU between Screening

Run-In Phase Visit I and Randomization/Baseline Visit (measured post-debridement)

1. Blood chemistry or counts values as follows (based on subject's medical files):

2. Pre-albumin 60 mg/dL

3. Serum creatinine >4. 0 mg/dL

4. WBC