MODIFICATION TO: COLLAGEN TOPICAL WOUND DRESSING

K040558 · Collagen Matrix, Inc. · KGN · Mar 17, 2004 · SU

Device Facts

• Record ID: K040558
• Device Name: MODIFICATION TO: COLLAGEN TOPICAL WOUND DRESSING
• Applicant: Collagen Matrix, Inc.
• Product Code: KGN · SU
• Decision Date: Mar 17, 2004
• Decision: SESE
• Submission Type: Special
• Device Class: Class U
• Attributes: Therapeutic

Intended Use

Collagen Topical Wound Dressing is indicated for the management of moderately to heavily exudating wounds and to control minor bleeding. Collagen Topical Wound Dressing may be used for the management of exudating wounds such as: - Pressure ulcers - Venous stasis ulcers - Diabetic ulcers - Acute wounds, for example trauma and surgical wounds - Partial-thickness burns

Device Story

Collagen Topical Wound Dressing is an opaque, absorbent, collagen membrane matrix; supplied sterile for single use. Applied topically to manage exudating wounds and control minor bleeding. Used in clinical settings for wound management; aids healing by providing a collagen matrix. No complex electronics or software involved.

Clinical Evidence

Bench testing only. Biocompatibility testing performed per ISO 10993-1. No clinical data presented.

Technological Characteristics

Collagen membrane matrix; absorbent; opaque. Biocompatibility tested per ISO 10993-1. Sterile, single-use.

Indications for Use

Indicated for management of moderately to heavily exudating wounds and control of minor bleeding in patients with pressure ulcers, venous stasis ulcers, diabetic ulcers, acute wounds (trauma/surgical), and partial-thickness burns.

Predicate Devices

• Collagen Topical Wound Dressing (K030921)
• Collagen Topical Wound Dressing (K040211)

Submission Summary (Full Text)

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MAR 1 7 2004

K040558
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# 510(k) Summary of Safety and Effectiveness

| Applicant Name and Address: Collagen Matrix, Inc. | 509 Commerce Street<br>Franklin Lakes, New Jersey 07417 |
|---------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------|
| Contact Person: | Peggy Hansen, RAC<br>Director, Clinical, Regulatory, and Quality Assurance<br>Tel: [phone]<br>Fax: [phone] |
| Date of Summary: | March 2, 2004 |
| Device Common Name: | Collagen Topical Wound Dressing |
| Device Trade Name: | To be determined |
| Device Classification Name: | Dressing, Wound, Collagen<br>Unclassified<br>KGN |
| Predicate Device(s): | Collagen Topical Wound Dressing, K030921<br>Collagen Topical Wound Dressing, K040211 |

### Description of the Device

Collagen Topical Wound Drcssing is an opaque, absorbent, collagen membrane matrix intended for topical use. The product is supplied sterile and for single use only.

## Indications for Use

Collagen Topical Wound Dressing is indicated for the management of moderately to heavily exudating wounds and to control minor bleeding.

Collagen Topical Wound Dressing may be used for the management of exudating wounds such as:

- . Pressure ulcers
- Venous stasis ulcers .
- Diabetic ulcers .
- Acutc wounds, for example trauma and surgical wounds .
- . Partial-thickness burns

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K040558
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# Summary/Comparison of Technical Characteristics

Collagen Topical Wound Dressing has the same fundamental scientific technology and intended use as the predicate device. In particular, the Collagen Topical Wound Dressing and its predicate are the same with respect to intended use, material, source, sterilization, etc.

## Safety

Collagen Topical Wound Dressing has been evaluated by a number of tests to assess its safety/biocompatibility. The device passed all applicable ISO 10993-1 testing for the biological evaluation of medical devices.

## Conclusion

The results of the in vitro product characterization studies and biocompatibility studies show that the Collagen Topical Wound Dressing is safe and substantially equivalent to its predicate device.

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three stripes representing the three levels of government: federal, state, and local. The eagle is encircled by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA".

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAR 1 7 2004

Ms. Peggy Hansen, RAC Director, Clinical, Regulatory, and Quality Assurance Collagen Matrix, Inc. 509 Commerce Street Franklin Lakes, New Jersey ()7417

Re: K040558

Trade/Device Name: Collagen Topical Wound Dressing Regulatory Class: Unclassified Product Code: KGN Dated: March 2, 2004 Received: March 5, 2004

Dear Ms. Hansen:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Fedcral Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can he found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination docs not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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Page 2 - Ms. Peggy Hanson, RAC

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Miriam C. Provost

(Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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# Indications for Use

KO40559 510(k) Number (if known):

Device Name: _________________________________________________________________________________________________________________________________________________________________ Collagen Topical Wound Dressing

Indications for Use:

Collagen Topical Wound Dressing is indicated for the management of moderately to heavily exudating wounds and to control minor bleeding.

Collagen Topical Wound Dressing may be used for the management of exudating wounds such as:

- . Pressure ulcers
- Venous stasis ulcers .
- Diabetic ulcers .
- Acute wounds, for example trauma and surgical wounds .
- Partial-thickness burns .

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE EIELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Miriam C. Provost

(Division Sign-Off) Division of General, Restorative. and Neurological Devices

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**510(k) Number** K040558