§ Study context:~CACIPLIQ20® is a bioengineered structural analogue of heparan sulfate glycosaminoglycans. Numerous experimental studies have provided strong evidence that CACIPLIQ20® promotes tissue regeneration by reconstructing the cellular microenvironment following tissue injury. Case studies collected in various clinical settings support the clinical interest of CACIPLIQ20® in the management of hard-to-heal chronic wounds.~CACIPLIQ20® is currently a class III CE marked medical device (NSAI-0050 CE MARK ECDEC-NL-A4) with the following indications:~Chronic ulcers showing no tendency to heal after 6 months of standard care, or still unhealed after 12 months, such as:~Pressure ulcers;~Peripheral arterial disease (such as Stage IV Leriche & Fontaine) ulcers;~Diabetic ulcers (including amputation).~CACIPLIQ20® is available in various European and non-European countries and currently primarily used in managing hard-to-heal wounds.~Therefore, there is an opportunity to organize a prospective and standardized recording of patients' data followed in real-life conditions to appreciate the benefits of a therapeutic strategy including CACIPLIQ20® use and to collect data that may help to highlight its efficacy and safety and estimate its cost-effectiveness.~§ Hard-to-heal leg/foot ulcerations:~Leg ulcers of venous, mixed or arterial origin as well as neuropathic or neuroischaemic diabetic foot ulcers represent the most prevalent chronic wounds followed and managed in daily practices.~Arterial leg ulcers and Diabetic foot ulcers (DFU)s (especially for neuroischaemic DFUs) have frequently a rather poor healing prognosis despite revascularization attempts and application of best local cares including, for DFUs, wearing of appropriate off-loading devices. The risk of deciding minor or major lower limb amputation is high and the chance to obtain wound closure at 20-24 weeks is, at the best, around 20-30%.~For leg ulcers of venous origin (ankle brachial pressure index (ABPI) ≥0.8) or of mixed origin (ABPI ranges between 0.6 and 0.8), the healing prognosis is better with application of best local cares and the use when the ABPI is >0.7 or 0.8 of an efficient venous bandaging. Nevertheless, when initiating the management of large old wounds (area >10 cm² and ulcer present for at least 6 months) the chance to obtain wound closure at 20-24 weeks is of 20-30% at best.~This survey will specifically include patients presenting a hard-to-heal foot/leg ulceration such as: leg ulcers of predominantly venous origin but with an ulcer surface >10 cm² and/or an estimated wound duration of at least 5 months, leg ulcer with arterial participation including critical limb ischemia, or neuropathic and neuroischaemic DFUs.~§ Study organization:~The inclusion of patients is decided the day when the addition of CACIPLIQ20® to the standard of local care is decided. The follow-up of the patient in the cohort will be carried out until the target wound is closed or up to a maximum of 20 weeks.~The inclusion and follow-up of patients are ensured, in agreement and in cooperation with the healthcare team of the subject, by doctors and expert nurses from the Cicat Occitanie network. This network relies on secured and validated teleconsultation tools. The inclusion of a patient in the cohort will not change the usual functioning of the network.
CACIPLIQ20® is currently a class III CE marked medical device available in various European and non-European countries, and currently primarily used in managing hard-to-heal wounds.~This study is a prospective and standardized recording of patients' data followed in real-life conditions to appreciate the benefits of a therapeutic strategy including CACIPLIQ20® use. It also aims at collecting data to follow-up the device's efficacy and safety and estimate its cost-effectiveness.