The Rampart wound matrix (Rampart DL Matrix) is a dehydrated, dual-layer human amniotic membrane allograft used as a protective biologic barrier over acute and chronic wounds. Each unit consists of two layers of amniotic tissue that retain the native extracellular matrix (ECM) proteins, including collagen types I and III, fibronectin, and hyaluronic acid, along with matrix-bound growth factors such as PDGF, TGF-beta, VEGF, and EGF. Rampart is minimally manipulated, stored at room temperature, and applied as a wound covering after debridement. It carries HCPCS code Q4347.
The Rampart wound dressing protocol is a six-step clinical workflow: assess the wound, cleanse the wound bed, debride non-viable tissue, rehydrate the membrane and apply it with full contact, secure a secondary dressing and offload, then reassess at each visit. Because Rampart is non-side specific, either surface can contact the wound bed, which simplifies placement compared with orientation-specific grafts.
This guide covers product composition, the step-by-step application protocol, indications, documentation and coding requirements, and how Rampart compares with single-layer dehydrated and cryopreserved alternatives. It is written for wound care physicians, podiatrists, orthopedic surgeons, and wound center coordinators who evaluate and apply amniotic membrane products in clinical practice.
Product composition and mechanism
Human amniotic membrane has been used in wound care for over a century. Modern processing preserves the tissue's biological activity while making it practical for routine clinical use. The membrane carries a dense extracellular matrix rich in collagen and adhesion proteins, along with a concentrated payload of growth factors that support angiogenesis, epithelialization, and inflammation modulation.[7]
Rampart is processed through controlled dehydration, which removes moisture while preserving the structural integrity of matrix proteins and the reservoir of growth factors bound to the ECM. Dehydrated amniotic membrane allografts retain biological activity despite the absence of viable cells; paracrine signaling from matrix-bound cytokines, rather than living cells, is thought to drive the majority of the wound-healing response.[7][8] The dual-layer construction provides two sheets of amniotic tissue, which adds mechanical strength during handling and application.
Dehydrated amniotic membrane products are regulated under FDA 361 HCT/P provisions as minimally manipulated human tissue for homologous use as a wound covering or barrier. They are not classified as drugs or devices and do not carry specific FDA-approved wound-healing claims.
Key terms defined
- Rampart DL Matrix: The specific dual-layer dehydrated amniotic membrane product. "DL" stands for dual layer. HCPCS code Q4347.
- Dehydrated amniotic membrane: Amniotic tissue processed by controlled moisture removal. Stable at room temperature. Rehydrated in sterile saline before application. Contrast with cryopreserved membrane, which is stored frozen.
- Wound matrix: A biologic or synthetic scaffold placed over a wound to provide structural support for cell migration and tissue remodeling. Amniotic membrane functions as a biologic wound matrix.
- Extracellular matrix (ECM): The non-cellular network of collagen, fibronectin, laminin, and other proteins that provides structural and biochemical cues to surrounding cells.
- Minimally manipulated: An FDA regulatory term meaning the tissue's biological characteristics are not altered beyond routine processing (cleaning, dehydration, sterilization).
- Non-side specific: Either surface of the membrane can be placed against the wound bed, unlike some grafts that require a specific orientation (basement membrane side down).
Wound bed preparation and skin integrity
The foundation of any advanced wound therapy is a properly prepared wound bed. Cox (2019) outlines the core components of wound care as assessment, cleansing, debridement, moisture balance, and periwound skin protection.[3] Carlin (2022) emphasizes that structured assessment of impaired skin integrity is essential for selecting an appropriate intervention and monitoring progress.[1] Powers et al. (2016) frame chronic wound management around correcting underlying pathophysiology, controlling bioburden, and addressing systemic risk factors.[2]
These principles establish the conditions under which any skin substitute, including Rampart, is most likely to succeed: a clean, perfused, well-debrided wound bed with controlled edema and infection. A systematic review by Paggiaro et al. (2018) confirmed that amniotic membrane products produce measurable biological effects on diabetic foot wounds, including modulation of inflammation and support for granulation tissue formation, when applied to appropriately prepared wounds.[7]
Indications: when to consider Rampart
Rampart is used for full-thickness acute and chronic wounds where a biologic barrier or protective covering is needed. Common indications include:
- Diabetic foot ulcers that have stalled under standard of care
- Venous leg ulcers with inadequate progress after compression therapy
- Pressure injuries (Stage III and IV)
- Arterial ulcers and mixed arteriovenous ulcers
- Surgical wounds and wound dehiscence
- Deep partial-thickness and full-thickness burns
- Traumatic wounds with tissue loss
A skin substitute should be considered after standard of care has been optimized and the wound has demonstrated inadequate progress. Practical prerequisites include a reasonable trial of conservative management, confirmed adequate arterial perfusion, infection control, offloading or pressure redistribution, and optimization of comorbidities such as diabetes and malnutrition.
Special populations require extra judgment. In older adults, skin fragility, moisture-associated skin damage, and polypharmacy can alter the wound trajectory.[5] In oncology patients, radiation injury, immunosuppression, and altered healing from chemotherapy require individualized decision-making.[6]
Clinical protocol: applying the Rampart wound dressing
- Assess. Measure wound dimensions, depth, undermining, tunneling, exudate, signs of bioburden, and periwound skin condition.[1][3] Document baseline photography and quantitative measurements.
- Cleanse. Use a non-cytotoxic cleanser appropriate to the wound bed and periwound skin. Milne (2019) emphasizes that skin cleansing preserves barrier function and supports the wound environment.[4]
- Debride. Remove non-viable tissue to expose a viable wound bed. Maintain hemostasis before graft placement.[2]
- Rehydrate and apply. Place the Rampart membrane in sterile saline or lactated Ringer's solution for 2-3 minutes until pliable. Because Rampart is non-side specific, either surface can contact the wound bed. Trim to wound size, place with full contact across the wound surface, and ensure edges extend slightly beyond the wound margin.
- Dress and offload. Apply a non-adherent secondary dressing that manages exudate without macerating periwound skin. Offload pressure areas and immobilize shear-prone sites.
- Reassess. At each visit, re-measure and photograph the wound. Document changes in granulation tissue, epithelialization, exudate, and pain. Continue or discontinue therapy based on response. A recent registry study of dehydrated amniotic membrane allografts demonstrated clinical benefit across a variety of chronic wound types and patient conditions in real-world practice.[9]
How Rampart compares to other amniotic membrane products
| Feature | Rampart DL Matrix | Single-layer dehydrated | Cryopreserved |
|---|---|---|---|
| Layer count | Dual layer (two sheets) | Single layer | Typically single layer |
| Processing | Dehydrated | Dehydrated | Frozen (sub-zero) |
| Storage | Room temperature | Room temperature | -20C or colder |
| Preparation | 2-3 min rehydration | 2-3 min rehydration | 10-15 min thaw |
| Orientation | Non-side specific | Varies by product | Typically side-specific |
| HCPCS code | Q4347 | Product-specific Q-code | Product-specific Q-code |
| Cold chain required | No | No | Yes |
The dual-layer design and non-side specific application are the primary practical differences between Rampart and other dehydrated amniotic membrane products. Both features reduce application complexity: the dual layer adds handling strength for larger wounds, and the non-side specific orientation eliminates the risk of placing the wrong surface against the wound bed.
Documentation and coding
For each application, record the medical-necessity rationale, prior conservative care, wound characteristics (location, dimensions, depth, tissue type, exudate), graft size applied, lot number, application date, and patient response. Payers require detailed wound measurements and evidence of failure to progress before authorizing advanced biologics.
Report the skin substitute application using the appropriate CPT code from the 15271-15278 range, determined by body area (face, scalp, neck, hands, feet, or other) and total wound size. Bill the Rampart product itself under HCPCS Q4347 (Rampart DL matrix, per square centimeter). Ensure ICD-10-CM codes support the underlying etiology. Coverage policies and fee schedules change frequently, so verify current coding on the official CMS website rather than relying on recalled rates.
Frequently asked questions
What is the Rampart wound matrix?
The Rampart wound matrix (Rampart DL Matrix) is a dehydrated, dual-layer human amniotic membrane allograft used as a protective biologic barrier over acute and chronic wounds. It retains native extracellular matrix proteins and growth factors, is stored at room temperature, and is billed under HCPCS code Q4347.
What is the Rampart wound dressing protocol?
The protocol is six steps: assess and measure the wound, cleanse with a non-cytotoxic solution, debride to viable tissue, rehydrate the Rampart membrane in sterile saline for 2-3 minutes and apply it with full wound contact, cover with a secondary dressing and offload, then reassess at each visit with measurements and photography. Rampart is non-side specific, so either orientation can contact the wound bed.
What types of wounds is Rampart used for?
Rampart is used for full-thickness acute and chronic wounds, including diabetic foot ulcers, venous leg ulcers, pressure injuries (Stage III and IV), arterial ulcers, surgical wounds, deep partial-thickness and full-thickness burns, and traumatic wounds with tissue loss.
How does Rampart differ from other amniotic membrane products?
Rampart is a dehydrated dual-layer membrane stored at room temperature. Its dual-layer construction provides two sheets of amniotic tissue for added mechanical strength, and it is non-side specific so either surface can contact the wound bed. Cryopreserved products require frozen storage and a 10-15 minute thaw, while single-layer dehydrated products have one tissue layer.
What HCPCS code is used for Rampart?
Rampart DL Matrix is billed under HCPCS Q4347 (per square centimeter). The application procedure is reported with CPT codes 15271-15278 depending on wound location and size. Verify current rates on the CMS website, as fee schedules change.
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- Carlin AS. Essentials of wound care: assessing and managing impaired skin integrity. Nurs Stand. 2022. PMID: 36093637.
- Powers JG, et al. Wound healing and treating wounds: Chronic wound care and management. J Am Acad Dermatol. 2016. PMID: 26979353.
- Cox J. Wound Care 101. Nursing. 2019. PMID: 31568079.
- Milne J. The importance of skin cleansing in wound care. Br J Nurs. 2019. PMID: 31242107.
- Reddy M. Skin and wound care: important considerations in the older adult. Adv Skin Wound Care. 2008. PMID: 18769169.
- McNees P. Skin and wound assessment and care in oncology. Semin Oncol Nurs. 2006. PMID: 16893742.
- Paggiaro AO, et al. Biological effects of amniotic membrane on diabetic foot wounds: a systematic review. J Wound Care. 2018. PMID: 29419367.
- Hao Y, et al. Biological characterization of dehydrated amniotic membrane allograft: Mechanisms of action and implications for wound care. J Biomed Mater Res Part B. 2020. PMID: 32458591.
- Snyder RJ, et al. Dehydrated human amnion/chorion membrane allograft with spongy layer to significantly improve the outcome of chronic non-healing wounds. Int Wound J. 2024. PMID: 37661177.