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Barbachowska A, Korzeniowski T, Surowiecka A, Strużyna J. Alloplastic Epidermal Skin Substitute in the Treatment of Burns. Life (Basel) 2023; 14:43. [PMID: 38255658 PMCID: PMC10821452 DOI: 10.3390/life14010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
The goal of burn wound treatment is to ensure rapid epithelialization in superficial burns and the process of rebuilding the lost skin in deep burns. Topical treatment plays an important role. One of the innovations in the field of synthetic materials dedicated to the treatment of burns is epidermal skin substitutes. Since the introduction of Suprathel®, the alloplastic epidermal substitute, many research results have been published in which the authors investigated the properties and use of this substitute in the treatment of wounds of various origins, including burn wounds. Burn wounds cause both physical and psychological discomfort, which is why ensuring comfort during treatment is extremely important. Alloplastic epidermal substitute, due to its biodegradability, plasticity, no need to remove the dressing until healing, and the associated reduction in pain, is an alternative for treating burns, especially in children.
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Affiliation(s)
- Aleksandra Barbachowska
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Lęczna, Poland; (A.B.); (A.S.); (J.S.)
- Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Lęczna, Poland; (A.B.); (A.S.); (J.S.)
- Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
| | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Lęczna, Poland; (A.B.); (A.S.); (J.S.)
- Department of Plastic and Reconstructive Surgery and Microsurgery, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Lęczna, Poland; (A.B.); (A.S.); (J.S.)
- Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
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Surowiecka A, Barańska-Rybak W, Strużyna J. Multidisciplinary Treatment in Toxic Epidermal Necrolysis. Int J Environ Res Public Health 2023; 20:2217. [PMID: 36767584 PMCID: PMC9916139 DOI: 10.3390/ijerph20032217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Toxic epidermal necrolysis, Leyll's syndrome (TEN), is a rare mucocutaneous blistering disease burdened with high mortality rates. The diagnosis of TEN is based on clinical symptoms and histopathological findings. In approximately 90% of cases, it is a severe adverse reaction to drugs. In TEN, not only is the skin affected, but also mucosa and organs' epithelium. There are no unequivocal recommendations in regard to systemic and topical treatment of the patients. The aim of this paper is to review available literature and propose unified protocols to be discussed. Early management and multidisciplinary treatment are necessary to improve patients' outcome. Treatment of patients with TEN suspicions should be initiated with early drug withdrawal. TEN patients, like patients with burns, require intensive care and multidisciplinary management. Each patient with TEN should be provided with adequate fluid resuscitation, respiratory support, nutritional treatment, pain control, infection prophylaxis, anticoagulant therapy, and gastric ulcer prophylaxis. The key to local treatment of patients with TEN is the use of nonadherent dressings that do not damage the epidermis during the change. The aim of the systemic treatment is purification of the blood stream from the causative agent. The most efficient way to clarify serum of TEN patients' is the combination of plasmapheresis and IVIG. Immunomodulatory therapy can reduce the mortality five times in comparison with the patients with immunosuppression or lack of full protocol.
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Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 20-059 Lublin, Poland
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 20-059 Lublin, Poland
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-059 Lublin, Poland
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Surowiecka A, Strużyna J, Winiarska A, Korzeniowski T. Correction: Surowiecka et al. Hydrogels in Burn Wound Management-A Review. Gels 2022, 8, 122. Gels 2022; 9:gels9010037. [PMID: 36661839 PMCID: PMC9821006 DOI: 10.3390/gels9010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/02/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023] Open
Abstract
In the original publication, there was a mistake in Table 2 as published [...].
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Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Correspondence:
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 21-093 Lublin, Poland
| | - Aleksandra Winiarska
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland
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Surowiecka A, Chrapusta A, Klimeczek-Chrapusta M, Korzeniowski T, Drukała J, Strużyna J. Mesenchymal Stem Cells in Burn Wound Management. Int J Mol Sci 2022; 23:ijms232315339. [PMID: 36499664 PMCID: PMC9737138 DOI: 10.3390/ijms232315339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/09/2022] Open
Abstract
Mesenchymal stem cells have a known regenerative potential and are used in many indications. They secrete many growth factors, including for fibroblasts (FGF), endothelium (VEGF), as well as 14 anti-inflammatory cytokines, and they stimulate tissue regeneration, promoting the secretion of proteins and glycosaminoglycans of extracellular matrices, such as collagen I, II, III, and V, elastin, and also metalloproteinases. They secrete exosomes that contain proteins, nucleic acids, lipids, and enzymes. In addition, they show the activity of inactivating free radicals. The aim of this study was an attempt to collect the existing literature on the use of stem cells in the treatment of a burn wound. There were 81 studies included in the analysis. The studies differed in terms of the design, burn wound model, source of stem cells, and methods of cellular therapy application. No major side effects were reported, and cellular therapy reduced the healing time of the burn wound. Few case reports on human models did not report any serious adverse events. However, due to the heterogeneity of the evidence, cellular therapy in burn wound treatment remains an experimental method.
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Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 21-010 Leczna, Poland
- Correspondence:
| | - Anna Chrapusta
- Malopolska Burn and Plastic Surgery Center, Ludwik Rydygier Memorial Hospital in Krakow, 31-826 Cracow, Poland
| | - Maria Klimeczek-Chrapusta
- Malopolska Burn and Plastic Surgery Center, Ludwik Rydygier Memorial Hospital in Krakow, 31-826 Cracow, Poland
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 21-010 Leczna, Poland
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland
| | - Justyna Drukała
- Department of Cell Biology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Krakow, 31-826 Cracow, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 21-010 Leczna, Poland
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-059 Lublin, Poland
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Surowiecka A. Combined therapies in scar treatment -the role of autologous derived agents in scar remodeling- a series of cases. Dermatol Ther 2022; 35:e15877. [PMID: 36181298 DOI: 10.1111/dth.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/03/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
Abstract
Comprehensive scar treatment usually requires a combination of several methods. The selection of methods should depend on the appearance and biology of the scar. The aim of this study was to determine the safety and efficiency of combined methods with the use of autologous derived agents in the treatment of scars, based on the available literature and own experience. The study consists of a description of 3 cases treated with autologous derived agents: platelet-rich plasma (PRP), lipofilling or stromal vascular fraction (SVF) in combination with radiofrequency, CO2 laser, or cutting threads. No adverse events were reported. Improvement in scar quality and function was observed in all cases. Combination of autologous derived injectables with medical devices is safe and accelerates both cosmetic and functional results. This article is protected by copyright. All rights reserved.
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Świerczewska Z, Lewandowski M, Surowiecka A, Barańska-Rybak W. Microbiome in Hidradenitis Suppurativa—What We Know and Where We Are Heading. Int J Mol Sci 2022; 23:ijms231911280. [PMID: 36232581 PMCID: PMC9570026 DOI: 10.3390/ijms231911280] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/27/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Recently, interest in the microbiome of cutaneous diseases has increased tremendously. Of particular interest is the gut-brain-skin axis proposed by Stokes and Pillsbury in 1930. The microbiome has been suggested in the pathogenesis of hidradenitis suppurativa, however the link between the commensals and the host is yet to be established. Across all studies, the increased abundance of Porphyromonas, Peptoniphilus, and Prevotella spp., and a loss of skin commensal species, such as Cutibacterium in HS lesions, is a consistent finding. The role of gut and blood microbiome in hidradenitis suppurativa has not been fully elucidated. According to studies, the main link with the intestine is based on the increased risk of developing Crohn’s disease and ulcerative colitis, however, further research is highly needed in this area. Lifestyle, dietary approaches, and probiotics all seem to influence the microbiome, hence being a promising modality as adjuvant therapy. The aim of this review was to present the latest reports in the field of research on skin, blood, and gut microbiome in terms of hidradenitis suppurativa.
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Affiliation(s)
- Zuzanna Świerczewska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
- Faculty of Medicine, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210 Gdansk, Poland
| | - Miłosz Lewandowski
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
- Faculty of Medicine, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210 Gdansk, Poland
| | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, District Hospital in Łęczna, ul. Krasnystawska 52, 21-010 Łęczna, Poland
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
- Correspondence:
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Korzeniowski T, Grywalska E, Strużyna J, Bugaj-Tobiasz M, Surowiecka A, Korona-Głowniak I, Staśkiewicz M, Torres K. Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns. J Clin Med 2022; 11:jcm11164800. [PMID: 36013039 PMCID: PMC9410402 DOI: 10.3390/jcm11164800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Early eschar removal is the standard management of burns. The goal is to remove all of the necrotic tissue and render the wound suitable for healing or skin grafting. The enzymatic debridement of burn wounds allows for minimally invasive removal of burn eschar. The aim of the study was to describe and compare the demographic characteristics, surgical treatment and outcomes of patients treated with Nexobrid® with patients who had standard surgical excision. Material and Methods: A retrospective review was conducted on children who underwent enzymatic debridement. The study group was compared with children treated with the standard of care (SoC). Results: Twelve children (mean age 8 years, range 3 to 15 years) with mixed deep dermal and full thickness burn wounds were treated with Nexobrid®. The mean size of the burns was 29% TBSA. The median percentage TBSA debrided using Nexobrid® was 15% (range 2–27%). In a clinical assessment, enzymatic debridement was effective in removing dead tissue in a single application. No adverse reaction to Nexobrid® and serious complications after enzymatic procedure were recorded in the study group. The estimated relative risk of the need for reconstructive procedures decreases 3.5 times for the study group (RR 3.5, 95%CI 0.9–13.5, p = 0.089). Conclusion: The bromelain-based enzymatic method offers a good and safe debridement option to improve the treatment and life quality of children with severe burns. The main outcome of interest was the number of reconstructive procedures due to scar contractures, which was reduced in the group treated enzymatically compared to the SoC-treated children.
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Affiliation(s)
- Tomasz Korzeniowski
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Correspondence:
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Chair and Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
| | | | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
| | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Magdalena Staśkiewicz
- Center for Innovation and Accreditation, Medical University of Lublin, 20-093 Lublin, Poland
| | - Kamil Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland
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Surowiecka A, Korzeniowski T, Strużyna J. Early burn wound excision in mass casualty events. Mil Med Res 2022; 9:42. [PMID: 35941705 PMCID: PMC9361563 DOI: 10.1186/s40779-022-00407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, 21-010, Łęczna, Poland.
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, 21-010, Łęczna, Poland.,Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093, Lublin, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010, Łęczna, Poland.,Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093, Lublin, Poland
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Strużyna J, Surowiecka A, Korzeniowski T, Piszczek J, Korulczyk P, Drozd L, Stachura A, Torres K, Krajewski A. Immunomodulatory treatment of Lyell's syndrome - a simultaneous plasmapheresis and IVIGs therapy. J Burn Care Res 2022; 43:1394-1398. [PMID: 35396849 DOI: 10.1093/jbcr/irac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Lyell's syndrome, or toxic epidermal necrolysis (TEN) is a rare but life-threatening condition. It manifests with blistering of skin and mucous due to subepidermal bullae and keratinocyte necrosis. In most cases it is an immune response to drugs or their metabolites. The mortality in TEN is high despite optimal infection and wound control. There are no unequivocal treatment guidelines in TEN. Immunosuppressive treatment may increase the wound infection risk and mortality. The aim of the study was to evaluate a 10-year experience with immunomodulatory therapy in TEN. We perform a combination of plasmapheresis and IVIGs to control the disease. There were 35 patients in the group and we performed a post hoc evaluation. 28 patients received the full protocol and there were 7 patients who did not complete the treatment (single therapy group). The mortality in the test group was 14,29%, and the difference reached statistical significance in comparison with the single therapy group (p<0.05). Our protocol reduced the mortality risk 5 times. Our study proved that simultaneous plasmaphereses with IVIGs administration was safe and improved patients' outcome in TEN.
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Affiliation(s)
- Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Poland
| | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,West Pomeranian Burns and Plastic Surgery Center, Gryfice, Poland
| | - Joanna Piszczek
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Poland
| | - Patrycja Korulczyk
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
| | - Lukasz Drozd
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland
| | - Aldona Stachura
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland
| | - Kamil Torres
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
| | - Andrzej Krajewski
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,West Pomeranian Burns and Plastic Surgery Center, Gryfice, Poland
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Korzeniowski T, Strużyna J, Chrapusta AM, Krajewski A, Kucharzewski M, Piorun K, Nowakowski J, Surowiecka A, Kozicka M, Torres K. A Questionnaire-Based Study to Obtain a Consensus from 5 Polish Burns Centers on Eschar Removal by Bromelain-Based Enzymatic Debridement (Nexobrid®) in Burns Following the 2020 Updated European Consensus Guidelines. Med Sci Monit 2022; 28:e935632. [PMID: 35064095 PMCID: PMC8790933 DOI: 10.12659/msm.935632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The supplementary treatment of burns with enzymatic debridement with Nexobrid® was approved in Europe in 2013. The 2017 European consensus guidelines on the removal of eschar in burns by bromelain-based enzymatic debridement were updated in 2020. This questionnaire-based study aimed to obtain a consensus from 5 Polish burns centers on eschar removal by Nexobrid® in burns following the 2020 updated European consensus guidelines. Material/Methods A panel of 5 experts representing the leading burn treatment centers in Poland (Cracow, Gryfice, Siemanowice Śląskie, Poznań, and Łęczna) was convened. A modified Delphi process was implemented with panel member selection, literature review, 2 rounds of voting in which panelists were asked to evaluate the European consensus and Polish consensus building by data analysis, statements preparation, final voting, and manuscript drafting. Results The knowledge and experience of experts from Poland’s leading burn centers resulted in the development of guidelines, formulated as 24 statements representing the following areas: indications and usage, pain management, application principles, post-enzymatic debridement wound dressing, and early and long-term outcomes. An analysis of the 7-point Likert scale polls revealed that 23 of the 24 statements achieved 100% consensus. Conclusions The findings from this survey from 5 major centers in Poland supported the main recommendations from the 2020 updated European consensus guidelines on the removal of eschar in burns by Nexobrid® and may serve as a practical guide for surgeons who care for patients with burns in this country.
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Affiliation(s)
- Tomasz Korzeniowski
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
| | - Jerzy Strużyna
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
| | - Anna M. Chrapusta
- The Małopolska Center for Burns and Plastic Surgery, Ludwik Rydygier Memorial Specialized Hospital in Cracow, Cracow, Poland
| | - Andrzej Krajewski
- West Pomeranian Center of Treating Severe Burns and Plastic Surgery, Hospital in Gryfice, Gryfice, Poland
| | - Marek Kucharzewski
- Chair and Department of Descriptive and Topographic Anatomy, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Piorun
- West Pomeranian Center of Treating Severe Burns and Plastic Surgery, Hospital in Gryfice, Gryfice, Poland
| | - Jakub Nowakowski
- Department of Trauma, Burns and Plastic Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Agnieszka Surowiecka
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
| | - Magdalena Kozicka
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
| | - Kamil Torres
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
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Strużyna J, Surowiecka A, Korzeniowski T. Letter to the Editor on Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020. Burns 2021; 47:1929-1930. [PMID: 34696955 DOI: 10.1016/j.burns.2021.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland; Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Poland
| | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland; Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
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Surowiecka A, Piekarski M, Pototschnig H. Stromal vascular fraction and emulsified fat as regenerative tools in rejuvenation of the lower eyelid area. Dermatol Ther 2021; 34:e14937. [PMID: 33704865 DOI: 10.1111/dth.14937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/02/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022]
Abstract
In the lower eyelid area, dermal melanocytosis, fine lines, skin atrophy, dryness, and loss of subcutaneous fat tissue represent the initial signs of aging. Beside the addition of volume, adipose tissue injections can also improve pigmentation and skin texture. Clinical studies of simultaneous stromal vascular fraction (SVF) and emulsified fat transfers have not been reported so far. Our aim was to investigate the clinical results of transferring SVF and emulsified fat into the lower eyelid area. A total of 16 patients underwent tumescent liposuction and injection of SVF and emulsified fat into the lower eyelid area. For preparation of SVF and emulsified fat, ACP double syringes with 2.4, 1.4, and 1.2 mm connectors, and a swing-out rotor centrifuge, were used. At follow-up, improvements on before and after pictures were rated by the treating physician and two independent physicians, using the global aesthetic improvement scale (GAIS). Clinical outcomes were rated as exceptional, very improved, or improved in all patients, with an average GAIS score of 1.6. No serious adverse events occurred. Our initial results suggest that SVF and emulsified fat are safe and effective tools for skin rejuvenation and correction of volume deficiencies in the lower eyelid area. More studies need to be conducted to corroborate these encouraging findings.
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Sklinda K, Mruk B, Surowiecka A, Ciaś M, Paluch Ł, Andziak P, Walecki J. Role of Magnetic Resonance Spectroscopy in Evaluation of Cerebral Metabolic Status Before and After Carotid Endarterectomy/Thromboendarterectomy and Carotid Artery Stenting in Patients with Asymptomatic Critical Internal Carotid Artery Stenosis. Med Sci Monit 2020; 26:e927029. [PMID: 33377476 PMCID: PMC7781046 DOI: 10.12659/msm.927029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The relative efficacy of carotid endarterectomy (CEA)/thromboendarterectomy (TEA) and carotid artery stenting (CAS) already has been compared in randomized controlled trials and a meta-analysis, but only limited data exist describing the status of cerebral metabolism before and after these interventions. The aim of the present study was to compare metabolic changes before and after treatment of carotid stenosis and assess their potential clinical implications. MATERIAL AND METHODS Patients with asymptomatic unilateral critical internal CAS were imaged with proton 3T magnetic resonance spectroscopy (H-MRS) because the technique is more sensitive than regular magnetic resonance imaging for detection of the early signs of ischemic events. Abnormal metabolite ratios detected with H-MRS may precede actual morphological changes associated with hypoperfusion as well as reperfusion changes. Ipsilateral and contralateral middle cerebral artery vascular territories were both evaluated before and after vascular intervention. H-MRS was performed within 24 h before and after surgery. Correlations in the metabolic data from H-MRS for N-acetylaspartic acid (NAA)+N-acetylaspartylglutamate, creatinine (Cr)+phosphocreatinine, and phosphocholine+glycerophosphocholine (Cho) were sought. RESULTS H-MRS voxels from 11 subjects were analyzed. Values for dCho/CrI, dCho/CrC and Cho/Naal (P<0.001) were significantly higher ipsilaterally than contralaterally. Ratios for dNaa/ChoC and Cho/NaaC were significantly higher on the non-operated side (P<0.001). CONCLUSIONS H-MRS may be helpful for assessment of patients with CAS, particularly because unlike other modalities, it reveals postoperative changes in metabolic brain status. Initial results indicate the important role of perioperative neuroprotective treatment.
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Affiliation(s)
- Katarzyna Sklinda
- Department of Diagnostic and Interventional Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bartosz Mruk
- Department of Diagnostic and Interventional Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Agnieszka Surowiecka
- Department of Surgical Research and Transplantology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Marek Ciaś
- Department of Diagnostic and Interventional Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Łukasz Paluch
- Department of Diagnostic and Interventional Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Andziak
- Department of General and Vascular Surgery, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland.,Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jerzy Walecki
- Department of Diagnostic and Interventional Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Surowiecka A, Frączek M, Mruk B, Matejak-Górska M, Walecki J, Durlik M, Sklinda K. Normal Pancreas Graft Appearance in Magnetic Resonance Diffusion Tensor Imaging (DTI). Med Sci Monit 2020; 26:e920262. [PMID: 32829373 PMCID: PMC7461655 DOI: 10.12659/msm.920262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The main purpose of diagnostic imaging after pancreas transplantation is to exclude potential complications. As long as standard anatomical imaging such as sonography, contrast-enhanced computed tomography, and magnetic resonance imaging (MRI) are sufficient to display macroscopic vasculature, early changes within the graft caused by insufficient microperfusion will not be displayed for evaluation. MATERIAL AND METHODS Patients with pancreas allograft function in good condition were included in the study. No specific preparation was demanded before the MRI examination. The results of MRI were correlated with Igls criteria. It was a preliminary study to examine diffusion tensor imaging (DTI) value and safety in pancreas transplantation. RESULTS Our results indicated that higher fractional anisotropy (FA) values of the graft's head were associated with delayed graft function and insulin intake. We also compared grafts' images in early and late periods and found differences in T1 signal intensity values. DTI is a reliable noninvasive tool, requiring no contrast agent, to assess graft microstructure in correlation with its function, with FA values showing the most consistent results. By Igls criteria, no graft failure, 76% had optimal function, 10% had good function, and 14% had marginal function. CONCLUSIONS Our results suggest that DTI can be safely used in patients after pancreas transplantation and is advantageous in detecting early as well as late postoperative complications such as intra-abdominal fluid collection, malperfusion, and ischemia of the graft. Our findings correspond with clinical condition and Igls criteria. DTI is free of ionizing agents and is safe for kidney grafts.
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Affiliation(s)
- Agnieszka Surowiecka
- Department of Gastroenterological Surgery and Transplantation, Central Clinical Hospital of the Ministry of the Interior and Administration (CSK MSWiA), Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Frączek
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bartosz Mruk
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marta Matejak-Górska
- Department of Gastroenterological Surgery and Transplantation, Central Clinical Hospital of the Ministry of the Interior and Administration (CSK MSWiA), Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jerzy Walecki
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marek Durlik
- Department of Gastroenterological Surgery and Transplantation, Central Clinical Hospital of the Ministry of the Interior and Administration (CSK MSWiA), Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Katarzyna Sklinda
- Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
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15
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Surowiecka A, Pototschnig H. Can hydrogel dressings reduce patients' discomfort and side effects of facial platelet-rich plasma injections? Dermatol Ther 2020; 33:e13906. [PMID: 32594637 DOI: 10.1111/dth.13906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022]
Abstract
The literature shows that facial injection of platelet-rich plasma (PRP) is a safe and effective treatment modality. Serious adverse effects have not been reported so far. Nevertheless, side effects such as redness, edema, bruising, pain, pruritus, and heat sensation have been reported. Our goal was to assess the potential effects of hydrogel dressing after injection of PRP. PRP was prepared using an ACP double-syringe system and applied on face by intradermal microdeposit injections. One half of the face was covered with a cooled (20°C) hydrogel dressing for 20 minutes before and after PRP injection. Patients rated the levels of pain separately for both sides. Physician and patient rated the overall appearance of the skin, redness, swelling, bruising, and number of bruises straight after the procedure. At 6-month follow-up, the physician rated the global aesthetic outcome. Needle prick-induced pain and edema were rated less on the hydrogel side. Our results demonstrate a significant reduction of patient's discomfort and side effects through application of hydrogel dressings. Recovery has been accelerated and the overall appearance of the skin straight after the procedure has been rated significantly better than without dressing application. At 6-month follow-up, the global aesthetic improvement was rated equally on both sides.
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Affiliation(s)
- Agnieszka Surowiecka
- Department of Gastroenterological Surgery and Transplantation, Central Clinical Hospital of the Ministry of the Interior in Warsaw, Warsaw, Poland
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Surowiecka A, Feng S, Matejak-Górska M, Durlik M. Influence of Peritoneal or Hemodialysis on Results of Simultaneous Pancreas and Kidney Transplant. EXP CLIN TRANSPLANT 2019; 18:8-12. [PMID: 31724922 DOI: 10.6002/ect.2019.0204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The influence of peritoneal dialysis on outcomes after simultaneous pancreas and kidney transplant is still vague. In addition, whether peritoneal dialysis leads to a higher risk of infectious complications and higher mortality rates in these transplant patients has not been unambiguously confirmed. In this study, our aim was to verify whether dialysis type determined outcomes on the pancreas graft and whether dialysis type was a risk factor for graftectomy or recipient death. MATERIALS AND METHODS Our study group included 44 simultaneous pancreas and kidney transplant patients. Analyzed parameters included type and duration of dialysis treatment, age, sex, long-term pancreas graft survival and patient survival, overall mortality, and number of graftectomies. RESULTS Of 44 patients, 3 (7%) required a graftectomy. Mortality rate of the group was 5%. Of 44 patients, 33 had hemodialysis and 11 had peritoneal dialysis. In those who had hemodialysis, the mean duration of renal replacement therapy was 30.5 months, which was significantly longer than duration for those who had peritoneal dialysis (20.4 mo; P < .01). There were 3 graftectomies and 1 death in the hemodialysis group. In the peritoneal dialysis group, there were no graftectomies and 1 death, with no significant differences in the number of graftectomies and mortality rates between the groups. Long-term survival also did not differ between the groups. CONCLUSIONS We found that type of dialysis did not affect outcomes in our group of simultaneous pancreas and kidney transplant patients. Before transplant, each patient requires an individual approach to treatment. The type of dialysis performed should not be viewed as a contradiction for transplant.
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Affiliation(s)
- Agnieszka Surowiecka
- From the Department of Gastroenterological Surgery and Transplantation of Medical Centre of Postgraduate Education at the Central Clinical Hospital of the Ministry of the Interior in Warsaw, Warsaw, Poland; and the Mossakowski Medical Research Centre of the Polish Academy of Sciences, Department of Surgical Research and Transplantology, Warsaw, Poland
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