Maria Siemionow

University of Illinois at Chicago, Chicago, Illinois, United States

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Publications (196)440.85 Total impact

  • Can Ozturk, Safak Uygur, Maria Siemionow
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    ABSTRACT: The regeneration of the peripheral nerves after crush injuries are influenced by many factors, including scar tissue formation within and around the nerve and/or adhesions between the nerve and surrounding tissues. Wrapping the crushed nerve with a protective barrier reduces fibrosis, adhesion formation and may improve clinical outcomes. The ideal wrapping material should be able to protect nerve, prevent neuroma, inhibit adhesion, induce a minimal inflammatory reaction and stimulate axonal regeneration. Various types of autologeous, biologic and synthetic materials have been used as a protective barrier. In this chapter we introduce our epineural sheath patch model, briefly describe the harvesting technique and application to crushed nerve segment as a protective barrier.
    Plastic and Reconstructive Surgery: Experimental Models and Research Designs, Edited by Maria Z. Siemionow, 02/2015: chapter 64: pages 519-523; Springer-Verlag London., ISBN: 978-1-4471-6334-3
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    ABSTRACT: There are several animal models and numerous suturing techniques for microsurgical anastomoses. In this chapter we describe a rat model for microvascular training and research. Common techniques including interrupted suture, continuous suture, locking continuous, continuous horizontal mattress, interrupted horizontal mattress with eversion and sleeve are presented. Different patency testing methods are outlined and advantages and drawbacks of each suturing technique are discussed. In this chapter we also present common rat models for arterial and venous bypasses and grafts using the aorta, carotids, iliac, and femoral vessels. Potential research application of each graft is discussed. Finally, different techniques to manage size discrepancies in microvascular anastomosis are summarized.
    Plastic and Reconstructive Surgery-Experimental Models and Research Designs, Edited by Maria Z. Siemionow, 02/2015: chapter Arterial and Venous Microanastomosis Models; Springer-Verlag London., ISBN: 978-1-4471-6334-3
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    ABSTRACT: PURPOSE: Peripheral nerve injury (PNI) repair is a challenging task, resulting in unsatisfactory outcomes. Rat epineural sheath conduit supported with rat bone marrow-derived stromal cells demonstrated neuroregenerative potential. To bring this approach closer to clinical applications we developed a new biologic construct for nerve regeneration - human epineural conduit (hEC) consisting of human epineural sheath (hES) filled with human mesenchymal stem cells (hMSC). The aim of this study was to assess the feasibility of hEC on the PNI repair in the nude rat model. METHODS: Sciatic nerve defect (20mm) was created in 24 nude male rats. Animals were divided into four experimental groups: Group 1 - no repair; Group 2 - autograft; Group 3 - hES filled with saline; and Group 4 - hEC (supported with 3-4 x 10^6 hMSC ). hES was created by fascicles removal using pull-out technique. To ensure homogenicity of hMSC, cells were cultured for 14 days and immunostained for hMSC-specific markers prior to injection into the hES. Outcome assessment included: sensory pinprick (PP) and motor toe-spread (TS) tests at 1, 3, 6, 12 weeks. Somatosensory evoked potentials (SSEP), gastrocnemius muscle index (GMI), histomorphometry, fluorescent immunostaining for GFAP, NGF, S-100, HLA I / II, vWF and laminin B2 were performed 12 weeks post-surgery. RESULTS: Cultured hMSC expressed CD105, CD73 and CD90, and lacked expression of CD45, CD34, CD14, CD11b, CD79a, CD19 and HLA-DR surface molecules. No leakage of cells was observed at the time of injection during conduit implantation. hEC maintained its shape and integrity at 12 weeks following repair. No local inflammation or scarring was observed at the end of the follow up. Clinical evaluation and SSEP analysis confirmed sciatic nerve recovery in groups 3 and 4 with outcomes comparable to nerve autograft repair. Immunostaining showed presence of the hMSC in the conduit at 12 weeks post-implantation. Quantitative nerve and muscle histological analysis is currently in progress. CONCLUSION: The feasibility of the application of hEC for restoration of PNI was successfully confirmed in this study. The functional outcomes following the use of hEC were comparable to the golden standard of autograft repair. hEC is a promising new technology for regeneration of long nerve gap defects which combines the effect of neurotropic properties of hES and immunomodulating properties of hMSC.
    Plastic &amp Reconstructive Surgery 10/2014; 134(4S-1 Suppl):67-68. · 3.33 Impact Factor
  • Plastic and Reconstructive Surgery 04/2014; 133(4 Suppl):994. · 3.33 Impact Factor
  • Wojciech Konczalik, Maria Siemionow
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    ABSTRACT: Management of soft tissue deficits resulting from congenital abnormalities, trauma, systemic disease, and tumors is a particularly challenging field of plastic and reconstructive surgery. Fat grafting, a technique traditionally used in the correction of facial asymmetry, is commonly seen in aesthetic procedures which use the grafted fat for soft tissue augmentation and recontouring. Despite its widespread use in reconstruction and aesthetic surgery, therapeutic modalities applied in fat grafting are crude and the results of this intervention are unpredictable. The aim of this review was to present the most recent evidence regarding experimental studies and designs which confirmed or disproved fat volume expansion or fat maintenance after autologous fat grafting.
    Annals of plastic surgery 04/2014; 72(4):475-83. · 1.29 Impact Factor
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    ABSTRACT: Currently, only a few large animal models, including swine, dog, and nonhuman primate, are described for composite face transplantation studies and the literature lacks reports on the large animal model of composite auricular transplantation. Large animal models offer better understanding of the immunological mechanisms and major histocompatibility complex characterization and, for this reason, are preferred to the small animal models for the assessment of new immunosuppressive tolerance induction protocols. Thus, the aim of this study was to demonstrate feasibility of dissection and exploration of vascular territories of the hemifacial and auricle transplantation models in the sheep cadavers. Ten cadaver sheep heads were studied. The vascular territories of the composite hemifacial flap and composite auricle flap were defined by anatomical dissection. Methylene blue staining and laser-assisted indocyanine green angiography using SPY Elite System were used for vascular territories assessment. The dissection of cadaver sheep heads confirmed that the hemifacial flap and auricle flap can be raised on the same pedicle consisting of the common carotid artery and jugular vein. An adequate vascular network was observed in the flaps after injection of methylene blue dye via the arterial pedicle. Laser-assisted indocyanine green angiography identified vascular territories of the hemifacial and auricular vascular network. We described a new hemifacial and an auricular transplantation models in the sheep cadavers and have confirmed presence of the adequate vascular network as demonstrated by the laser-assisted angiography. This study introduces 2 new large animal models into the armamentarium of vascular composite allotransplantation.
    Annals of plastic surgery 04/2014; 72(4):469-74. · 1.29 Impact Factor
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    ABSTRACT: Venous grafting has been widely used in microsurgical training. Different types of vascular grafts have been described in experimental models. In this study we describe for the first time the Y- and X-shaped vein grafts (YVG, XVG) with accompanying drain-out branches as a new tool for the microsurgical training and free flap applications in rats. Twelve adult male Lewis rats were used in this study. The dissections were performed to determine the average diameter and harvestable length of vein grafts in eight rats. In four rats vein grafts were applied for bridging of the common carotid artery gap, whereas the drain-out branches were used as the arterial source for single and bilateral free groin flap applications. The venous anastomoses of groin flaps were performed in end-to-end fashion to the external jugular vein and its branches. The patency of anastomoses was checked 72 hours after repair. The average length of the harvestable vein branches ranged between 5.2 to 11.8 mm. The average surgery time for repair of the arterial gap with the vein grafts was 40 minutes. The ischemia time for single and bilateral groin flap transfer using YVG and XVG was 30 and 70 minutes, respectively. The patency of the interpositional vein graft was 100%. Flap survival rates were 50%. These vein grafts can be used as an alternative technique for reconstruction of tissue defects that require arterial gap repair with single or multiple free flap applications and also as a new microsurgical training model.
    Journal of Reconstructive Microsurgery 02/2014; · 1.00 Impact Factor
  • American Society for Reconstructive Microsurgery 2014; 01/2014
  • Article: Abstract 64
    Plastic &amp Reconstructive Surgery 01/2014; 133:10-99. · 3.33 Impact Factor
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    ABSTRACT: Vascularized lymph node transfer is of high interest for the treatment of lymphedema. Currently, there are few experimental small animal models of vascularized lymph node transplantation. In this article, our aim was to describe a new vascularized cervical lymph node transplantation model in rats. Ten male Sprague-Dawley rats weighing 200 to 250 g were used in this study. The anatomic features of the neck lymph nodes in rats were explored. Anatomic neck dissections were performed, and lymph node flaps were harvested. The common carotid artery and the jugular vein were used as the vascular pedicles of the lymph node flap. Methylene blue dye was injected into the arterial pedicle. Lymph nodes were identified, and their structure was confirmed by histological evaluation. Laser-assisted indocyanine green angiography was used to confirm perfusion of the lymph node flap. An adequate perfusion was observed in the lymph node flap. The dye disseminated evenly within the lymph nodes, indicating that the flap had a well-established vascular network and an adequate blood supply. Macroscopically, perfusion of 5 to 6 lymph nodes was observed. Histological examination of tissue samples confirmed well-defined lymph nodes. After indocyanine green administration, fluorescence was observed throughout the lymph node flap and within the venous pedicle of the flap. To the best of our knowledge, this is the first report describing vascularized lymph node flap in the head and neck region of a rat. Our lymph node flap preparation technique confirmed the presence of 5 to 6 lymph nodes within the flap. The presented vascularized lymph node flap can be applied to transplantation studies, lymphedema studies, and to studies on immunological mechanism of tolerance and rejection.
    Annals of plastic surgery 12/2013; 71(6):671-674. · 1.29 Impact Factor
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    ABSTRACT: This review aims to present the most recent updates on face and upper-extremity allotransplantation. To date, 27 face and more than 89 upper-extremity allotransplantations have been performed. Both the face and hand transplants restored form, function and patients' social integration. The complications were comparable with solid organs; however, face transplantation, as well as the combination of face and double hand transplantation, presented with significant morbidity and mortality. Evidence of chronic rejection was confirmed in hand transplants, but it has not been reported yet for facial transplantation. Novel immunosuppressive protocols have allowed a decrease in the number and dosages of traditional immunosuppressants. With increased awareness that following face and hand transplantation, the return of function is more important than anatomical restoration of the missing parts, there has been an important shift in the ethical debate weighing the risks and benefits of face and hand allotransplantation. Early results after face and upper extremity transplantation are promising, with 5-year survival rates greater than in solid organ transplants. However, these procedures still need to be closely monitored and the outcome data should be rigorously reported to the central patient registry database to allow continuous surveillance.
    Current opinion in organ transplantation 10/2013; · 3.27 Impact Factor
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    ABSTRACT: Muscle denervation atrophy is a result of lower motor neuron injury, thus an early restitution of muscle stimulation is essential in prevention of atrophic changes. The aim of the study was to evaluate the new application of naturally occurring epineural sheath conduit in repair of the peripheral nerve gap to prevent development of muscle denervation atrophy. Material and methods. We used the model of 20 mm sciatic nerve gap, resulting in denervation atrophy of the gastrocnemius muscle in the diabetic rats (DM type 2, n=42, Zucker Diabetic Fatty strain). We applied the epineural sheath conduit created from the autologous sciatic nerve for gap repair. Muscle atrophy was assessed with the Gastrocnemius Muscle Index (GMI) and microscopic muscle morphometry (mean fiber area) at 6 and 12 postoperative week. Muscle regeneration in the experimental group was compared to the gold-standard technique of autologous nerve grafting for the repair of created nerve gap. Results. The GMI evaluation revealed comparable muscle mass restoration in groups with nerve repair using both epineural sheath and standard autologous nerve grafting (reaching 28 and 35% of contralateral muscle mass at 12 postoperative week, respectively, p=0.1), and significantly better restoration when compared to the negative control group (no repair, 20%, p<0.01). Micromorphometry confirmed significantly larger area of the regenerated muscle fibers in groups with both nerve grafting and epineural sheath conduit repair (reaching for both ca. 42% of the non-operated side), when compared to severe atrophic outcome when no nerve repair was performed (14% of the control fiber area, p<0.0001). The effectiveness of epineural conduit technique in muscle mass restoration was observed between 6 and 12 weeks after nerve repair - when gastrocnemius muscle mass increased by 12%. Conclusions. Peripheral nerve gap repair with naturally occurring epineural sheath conduit is effective in prevention of muscle denervation atrophy. This method is applicable in diabetic model conditions, showing results of regeneration which are comparable to the autologous nerve graft repair.
    Polish Journal of Surgery 07/2013; 85(7):387-94.
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    ABSTRACT: Peripheral nerve surgery performed under unfavorable conditions results in increased scar formation and suboptimal clinical outcomes. Providing the operated nerve with a protective barrier, reduces fibrosis and adhesion formation and may lead to improved outcomes. The ideal coverage material should prevent scar and adhesion formation, and maintain nerve gliding during motion. Nerve protection using autologous tissues has shown good results, but shortcomings include donor site morbidity and limited availability. Various types of methods and materials have been used to protect nerves. There are both advantages and disadvantages associated with the various materials and techniques. In this report we summarize currently used protective materials applied for nerve coverage under various surgical conditions. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013.
    Microsurgery 04/2013; · 1.62 Impact Factor
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    Maria Siemionow, Aleksandra Klimczak
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    ABSTRACT: The preclinical experimental models of vascularized composite allografts (VCAs) have been rapidly developed for the assessment of immunomodulatory protocols for clinical application. Recently, researchers have focused on immunomodulatory protocols which overcome the immunologic barrier between the allogeneic donor and recipient and may lead to tolerance induction. In order to test the feasibility of chimerism induction, experimental VCAs have been performed in different models including rodents, large animals, and nonhuman primates. These models differ in the complexity of transplanted tissue and in their responses to immunomodulatory protocols. In most applications, VCA contains multiple-tissue components; however, each individual component of CTA possesses unique immunologic characteristics that ultimately contribute to the chimerism induction and successful outcome of the VCA. Heterogenic character and complexity of tissue components in different VCA models determine the quality and robustness of donor-specific chimerism. As introduced in experimental studies, variable immunomodulatory options have been studied to achieve tolerance to VCA in rodents and large animal models allowing for widespread application in clinic. In this paper, based on our own experience, we have analyzed the current knowledge of tolerance-inducing strategies via chimerism induction in VCA experimental models in the context of immunomodulatory protocols and VCA complexity and their relevance and applicability to clinical practice.
    Clinical and Developmental Immunology 01/2013; 2013:831410. · 2.93 Impact Factor
  • Safak Uygur, Can Öztürk, Maria Siemionow
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    ABSTRACT: Pulsed acoustic cellular expression (PACE) is a treatment that applies focused acoustic shock waves to promote tissue healing. The aim of this study was to assess the effect of PACE treatment on inflammatory responses in a cremaster muscle ischemia/reperfusion injury model. Seventeen cremaster muscle flaps were evaluated in four groups: nonischemic controls (n = 5), 5-hour ischemia controls (n = 4), preischemic (5-hour) PACE conditioning (n = 4), and postischemic (5-hour) PACE conditioning (n = 4). The expression of proinflammatory cytokines (TNFα, IL-6, IL-1α, IL-1β, GM-CSF) and chemokines (CCL3, CCL4, CXCL4) was assessed using TaqMan® real-time PCR. Expression of ELAM-1, VCAM-1, and ICAM-1 was assessed by immunostaining. Preischemic PACE conditioning upregulated expression of IL-6, CCL3, CCL4, and CXCL4, and downregulated expression of TNFα, GM-CSF, and IL-1α. Postischemic PACE conditioning significantly decreased expression of all evaluated genes. Pre- and postischemic PACE conditioning decreased expression of ELAM-1 and ICAM-1. Results of the study indicate that application of PACE conditioning may have a beneficial effect on the recovery of tissues subjected to the ischemia/reperfusion injury. Postischemic PACE conditioning revealed anti-inflammatory effect as confirmed by decreased expression of inflammatory cytokines, chemokines, and cell adhesion molecules (ELAM-1 and ICAM-1) that are responsible for leukocyte recruitment into ischemic tissues. Hence, PACE therapy may be used effectively in clinical practice as a convenient therapeutic strategy to protect tissues against ischemia/reperfusion related injury after microsurgical procedures of free tissue transfers. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.
    Microsurgery 11/2012; · 1.62 Impact Factor
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    ABSTRACT: OBJECT: The gold standard for reconstructing large nerve defects, the nerve autograft, results in donor-site morbidity. This detrimental consequence drives the search for alternatives. We used a vein filled with a small piece of fresh muscle to prevent the vein from collapsing and with bone marrow stromal cells (BMSCs) to enhance regeneration. METHODS: In 60 rats, a 15-mm sciatic nerve defect was bridged with a nerve autograft, a vein filled with muscle or a vein filled with muscle and BMSCs. Toe spread and pinprick were used to evaluate motor and sensory function. Compound muscle action potentials (CMAPs) and the gastrocnemius muscle index (GMI) were recorded to assess conduction properties and denervation atrophy. Extensive histology was performed to confirm presence of BMSCs and to evaluate regeneration by staining neural tissue for Schwann cells and neural growth factor. RESULTS: After 12 weeks, all animals responded with toe spread and pinprick reaction; significant differences were found between groups. Six weeks post grafting no difference was found comparing the GMI between the groups. Group I had a significant increase in GMI at 12 weeks compared to group II and group III. The CMAP measurements showed comparable results at 6 weeks post grafting. Twelve weeks after reconstruction, group I had significantly better results compared to group II and group III. Group III showed a tendency to outperform group II at 12 weeks postoperatively. Immunofluorescence analysis showed an increased number of Schwann cells in group III compared to group II. The BMSCs were visible 6 and 12 weeks postoperatively. CONCLUSIONS: This study is a step forward in the search for an alternative to the nerve autograft because it demonstrates the beneficial effect of BMSCs to a conduit. However, our data do not demonstrate sufficient benefit to warrant clinical implementation at this stage.
    Journal of Plastic Reconstructive & Aesthetic Surgery 10/2012; · 1.47 Impact Factor
  • Maria Siemionow, Maria Madajka, Joanna Cwykiel
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    ABSTRACT: The main purpose of cellular therapy application in face transplantation is the continuous need for the development of new strategies that would eliminate the use of toxic immunosuppressive protocols. Cellular therapy in transplantation can significantly benefit allograft survival and shorten healing time. Cells used for a therapeutic purpose are isolated mostly from bone marrow and adipose tissues. They have the ability to proliferate and differentiate in the transplanted tissue and have immunomodulatory activity. Most of the cellular therapies such as T-regulatory, dendritic, and chimeric cells are still in the experimental stage. Molecular characterization of these cells and the mechanism of their participation in allograft acceptance and rejection are not well established and will contribute to the future of modern transplantology.
    Annals of plastic surgery 10/2012; · 1.29 Impact Factor
  • Maria Siemionow
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    ABSTRACT: This article summarizes the current knowledge on the new developing field of reconstructive transplantation. A brief outline of vascularized composite allografts (VCA) such as human hand, face, larynx, and abdominal wall transplants is provided. The clinical applications and indications for these new reconstructive transplantation procedures are outlined. The advantages, disadvantages, and complications and concerns surrounding clinical VCA are discussed. Finally, the impact of reconstructive transplantation on the future of plastic and reconstructive surgery is presented.
    Clinics in plastic surgery 10/2012; 39(4):425-34. · 0.95 Impact Factor
  • Brian Gastman, Risal Djohan, Maria Siemionow
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    ABSTRACT: There is a growing interest in the use of vascularized composite transplantation to reconstruct major facial and craniofacial deformities. This phenomenon is driven both by the success of recent transplantations to functionally and aesthetically restore patients and by an increase in the number of centers entering this challenging field. The authors' new classification system, based on a well-established schema, allows proper documentation of the needs of these patients and enhancement of interinstitutional communication for outcomes reporting.
    Plastic and Reconstructive Surgery 08/2012; 130(2):419-22. · 3.33 Impact Factor

Publication Stats

3k Citations
440.85 Total Impact Points


  • 2014
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 2002–2013
    • Cleveland Clinic
      • • Department of Plastic Surgery
      • • Department of Plastic and Reconstructive Surgery
      Cleveland, Ohio, United States
    • Marmara University
      • Department of Orthopaedics and Traumatology
      İstanbul, Istanbul, Turkey
    • Ankara Numune Training and Research Hospital
      Engüri, Ankara, Turkey
  • 2012
    • Brigham and Women's Hospital
      • Department of Medicine
      Boston, MA, United States
  • 2011
    • Massachusetts General Hospital
      • Division of Plastic and Reconstructive Surgery
      Boston, MA, United States
    • Partners HealthCare
      Boston, Massachusetts, United States
  • 2009–2011
    • Nicolaus Copernicus University
      • Department of Anesthesiology and Intensive Care
      Toruń, Kujawsko-Pomorskie, Poland
    • Gazi University
      • Faculty of Medicine
      Ankara, Ankara, Turkey
  • 2010
    • Gulhane Military Medical Academy
      • Department of Plastic and Reconstructive Surgery
      Engüri, Ankara, Turkey
  • 2007–2009
    • American Society of Ophthalmic Plastic and Reconstructive Surgery
      Cleveland, Ohio, United States
  • 2008
    • Kirikkale University
      • Department of Plastic and Reconstructive Surgery
      Кырыккале, Kırıkkale, Turkey
  • 1999
    • Universität zu Lübeck
      Lübeck Hansestadt, Schleswig-Holstein, Germany