Microcirculation Connection with Shock Wave Stimulation

Updated: Feb 27


Dr. Maria Siemionow

Dr. Maria Siemionow (born 1950 in Krotoszyn) is a Polish transplant surgeon and scientist who as Director of Plastic Surgery Research and Head of Microsurgical Training for Cleveland Clinic’s Department of Plastic Surgery, led a team of eight surgeons through the world's first near-total face transplant in 2008. The patient, Connie Culp, a 45-year-old woman from a small town in Ohio, was exceedingly disfigured by a close-range shotgun blast in 2004. The procedure took 22 hours.


Dr. Siemionow practiced in Cleveland until 2014, when she was appointed Professor of Orthopedics and Director of Microsurgery Research at The University of Illinois from Chicago, where she practices today.


She is regarded as a world leader in nerve regeneration enhancement and in developing minimal immunosuppression regimens following transplantation. Dr. Siemionow specializes in microsurgery, hand surgery, peripheral nerve surgery, transplantation and microsurgery research. She is President of the American society for Reconstructive Transplantation and is past president of both the International Hand and Composite Tissue Allotransplantation Society and the American Society for Peripheral Nerve. Dr. Siemionow is a member of the Warrior Restoration Consortium, an academic-industry team focused on developing new treatments for wounded soldiers.


Dr. Siemionow was twice honored with the James Barrett Brown Award for best publication in a plastic surgery journal in 2004 and 2007, and received the Folkert Belzeer Award in 2001. She is the recipient of the Commander's Cross Polonia Restituta award given by the President of Poland (2009), and in 2014, she received the Great Immigrants Award from the Carnegie Foundation of New York.


In December 2017, during the SANUWAVE’s Clinical and Science Symposium from Chateau Elan, Braselton, GA, USA, Dr. Maria Siemionow presented her research on the effects of the PACE® (Pulsed Acoustic Cellular Expression) technology on microcirculation. Her presentation also gave us the opportunity to talk with Dr. Siemionow on various subjects. The interview is presented below.


Dr. I. Cioanta: First of all, let me thank you very much for accepting to do this (interview) and for being here (at our Symposium), and you know there are a lot of things that we know about you and for example the first thing is you grew up in Poland, I grew up in Romania, and I know that were very demanding things to get into the medical school.


Dr. M. Siemionow: Sure.


Dr. I. Cioanta: And it may sound personal, but I need to think, you know, what or who practically inspired you to go to the medical school?


Dr. M. Siemionow: I think, generally it was my education in high school, which was very oriented to the humanitarian help, as well as the languages, and a little bit of the history from the ancient time, which they were putting a lot of emphases on, and ethics were taught in high school. That was a special high school, which was oriented towards just very humanitarian ideas. So, I think this is something, which I always thought that will be great to be able to be between people and help people.


Dr. I. Cioanta: I truly understand that. I had the same dilemma when I was young. Ha, ha! So, in your opinion right now, which are the most significant changes that practically are happening in this modern medicine, as it is practiced right now?


Dr. M. Siemionow: Well, there are certain changes. In a way the practice is not similar, but there are new opportunities, there are new, specifically in my field, new therapies, new devices, which are actually coming very fast into the practice. In the past, the surgeons were more conservative, in the way of using a method of a very well-known professor. And as you know, all surgical procedures have names – “Millard II” (rotation-advancement procedure for cleft lip repair, also known as the Millard Repair, is designed to create a softer, more natural-looking lip) and you know from the physician and so. So, in our days nobody really cares in terms of whose name is that? People more are thinking about well bringing to the table the innovation.


Dr. I. Cioanta: Yeah, right. So, if you are to describe yourself with one word what it gone be?


Dr. M. Siemionow: Consistent.


Dr. I. Cioanta: Ha, ha! That’s very important. For such a prestigious career, yeah, consistency it’s very important.


Dr. I. Cioanta: So, what or who inspires you every day or what motivates you to get out of bed in the morning, just to do whatever you have to do?


Dr. M. Siemionow: Well, I will say mostly young people I educate. So, as you know, I have a large laboratory, in University of Illinois in Chicago, where I have usually about ten (10) researchers. All of them are either early in their careers or in their PhDs. Some of them are just young after training, and all summer I have international students, many of them coming, of course from Poland, from Medical School, rotating for three (3) months. So, this is a constantly a powerful opportunity, first to teach them but also they challenge you. So, they ask questions, which sometimes you are not ready, because they think differently. And this is on the research part, but also I see the same, as an orthopedic hand surgeon. We have the largest program in Chicago. Fifty (50) residents of orthopedics. That’s huge, it’s the biggest in Chicago. So, also I give them lectures and they help me in the clinic and assist me. They ask questions or they don’t ask questions and then I ask them questions. And it’s a good vibrant opportunity to keep you, you know, I will say, young, because you try to be with them on the same line.


Dr. I. Cioanta: I agree. Ha, ha! Sometimes it is difficult to keep up with the young.


Dr. M. Siemionow: It is, it is.


Dr. I. Cioanta: So, your successful face transplant for Connie Culp is considered a big milestone in medicine. How that influenced your career and your life in general, after that significant event?


Dr. M. Siemionow: Sure. Well, my life was busy before. Become very busy. Now it will be, next year will be ten (10) years. So, there was at the beginning, for quite a while, we were the first and the only, so there was not only interest, of course with the media as usual, but also colleagues were interested. They were asking for the lectures, for presentations with details, procedure. We had most interest, it was always the fact that many of my colleagues in reconstructive plastic surgery, they were interested also in ethical protocol. Because bioethics and ethics approval of the IRB, Institutional Review Board, was a corner step to go forward. So, it become really very busy, and I think I enjoy it. I only traveled more than I even wish, at that time, and even today, even if there are more face transplants. We have done in fact two (2) more face transplants. So there are three (3) cases, three (3) patients under my protocol and under support of Department of Defense, where I have the contact list.


Dr. I. Cioanta: Yeah. So, I know that a lot of awards came after that and a lot of things for your prestigious career, and I have few of them together. The Polish Order of Merit that I think it is very dear for you.


Dr. M. Siemionow: Aha.


Dr. I. Cioanta: The 41 “great Immigrants” from the Carnegie Corp., the James Barrett Brown awards, the Folkert Belzeer award, Commander's Cross Polonia Restituta. So, a lot of awards and congratulations for such a prestigious, you know, career and accolades.


Dr. M. Siemionow: Thank you.


Dr. I. Cioanta: How do you get used to being such a celebrity?


Dr. M. Siemionow: Ah! Well it comes with timing, you know. So, I think you are getting used to that. One thing which I will say, as much as I appreciated the awards, I know they will end. So, I am not, you know, waiting for more. I am just, heck, there is another one from a different society, or an appreciation. And this is probably something, which (is) maybe just my personality. I think based on my education, I always was trying to do the best, and the best turned out to be also appreciated by others. And this is probably the most important part, because it looks like you are trying your best and people are recognizing it. So, that’s very fulfilling.


Dr. I. Cioanta: Yeah, and is also probably the fact, we are the first generation of immigrants, and we knew that, we knew to work harder than everybody else to be sure that we gone succeed. That’s kind of the mentality that can put you in front.


Dr. M. Siemionow: Exactly, absolutely. Yeah.


Dr. I. Cioanta: So, in relationship to your success and life approach, how do you push through your worst times?


Dr. M. Siemionow: Well, this maybe where you asked me about how I would define myself. It is consistency and patience. Because, you know it took four (4) years to get approval of the first face transplant protocol. And people didn’t’ believe, it will ever happen, because when I submitted the protocol to IRB, they were coming back with questions and there were other questions. And then finally after IRB approval, the major obstacle was the Organ Procurement Organizations. They didn’t want to approve the face transplant, because they were afraid that the donors of solid organ transplant will be scared. They didn’t understood that this is a special protocol, special consent. But now, ten (10) years later, face is considered an organ and was approved by UNOS (United Network for Organ Shearing) and was approved by all Organ Procurement Organizations, as an organ. So that’s a major milestone, which took ten (10) years. But in the beginning, it almost looked like will never happen.


Dr. I. Cioanta: It’s a reality that face transplant involves much more than anything else, because you have to attach everywhere the nerves, the vessels, the muscles and everything else.


Dr. M. Siemionow: Sure. Yeah.


Dr. I. Cioanta: It is very difficult and I see people not understanding from the beginning and putting a lot of questions and ethical stuff. So, what projects are you currently working on right now?


Dr. M. Siemionow: Clinically, we have just completed, this year there was a third face transplantation, still in Cleveland Clinic. And I am PI, Primary Investigator, even if I am at the University of Illinois of Chicago (UIC). This is the Department of Defense supported protocol. So it was logical that at least because the patients were already on the schedule and they were selected, so I am just still overviewing this. There is at UIC, I opened a hand surgery, a hand transplant program. So I got IRB approval, as well the UNOS approval, to hopefully perform first in Chicago area, a hand transplantation, which is really very rewarding. And as a hand transplant (surgeon) from the beginning of, as a hand surgeon from the beginning of my career, that’s also of my interest. On the research account though, I have really devoted a lot of time to new therapies, where we are performing the fusion between the donor and recipient cells, for tolerance induction in transplantation, creating these “chimeric” cells. But recently, and this is the big project, there was actually the IP (intellectual propriety/patents) at the university, and with my son Chris, we had spin-off the company out of the university. I have licensed this. We did it in Poland, and we have found very receptive and funding organization by grant and also by some of the supporters or sponsors. So, this is big because for Duchenne Muscular Dystrophy there is no cure apparently and we are creating a new generation of cells. We call them “DEC”, Dystrophy Expressing Chimeric cells, which are based on the fusion in between the father and the son. So the father’s cells are having dystrophy and the son’s cells are not having dystrophy. And after fusion, we are planning to treat them, because we have confirmed on the mouse model of Duchenne that actually we can bring dystrophy to the Duchenne mouse and this is correlating with increased function. So, that’s very exciting.


Dr. I. Cioanta: Wow! Very exciting and the fact that you reduced rejection, it is very important, because that is one of the problems with implants.


Dr. M. Siemionow: Exactly.


Dr. I. Cioanta: So, now because we are talking about research, maybe we can help with shock waves there, maybe we can see that we can stimulate those cells. But just going back to shock waves, do you find your work in the shock wave field enticing or intriguing?


Dr. M. Siemionow: I will say both probably, because in the beginning it was, you know, well totally new field. It was really more based on understanding of engineering than the medicine, because the way the shock wave works was first developed and checked more on, even for medical applications, in kidney stones and so on. Still was, the surgeons were the users or the physicians were the users. But I think there is a depth of education, which is to find ways to understand the process and to maybe even develop more. But there was interesting having in my lab experimental models, where we could see directly what is happening after application of shock waves or PACE therapy, as we call it now. It’s, it was really interesting to see the differences, which were directly applicable to my clinical practice of microsurgery. So, it was exciting as well.


Dr. I. Cioanta: Fantastic. So, where do you think that SANUWAVE should concentrate efforts?


Dr. M. Siemionow: Well, you have your, I will say, branding around the diabetic ulcers treatment, the clinical trial, you have the branding around the wound healing and you are very well known for that. I think, I will be presenting today at my lecture some other applications, which you know you may be interested in collaboration. But I think there is a void, which was never rechecked. It’s in the nerve regeneration. And application of the shock wave therapy, as we have spoken some time ago, to the stem cell therapy. So, that will be great.


Dr. I. Cioanta: That is a very interesting subject. So, where do you find most important things, when teach the new generation of physicians that they look up to you? What is the most important thing when you do that?


Dr. M. Siemionow: Well, you know just talking about being patient and persistent, I think this is important for new generation now. Because, they want it fast everything and if it’s not fast they just leave it, and they think, well let’s just try something else, and something else also is not fast. So, this becomes confusing. So, I think the first thing is to let them know that something which you want to achieve takes time, always was taking time, maybe faster now than before, but that’ s not all now. But also in a way when you are fast you are losing distance and you are not paying attention to detail and, you know, it is so easy now to learn so much over internet, but you are getting a very superficial knowledge, I mean if you go fast. If you go deep takes time, but nobody wants to take time. Ha, ha! So this is a “double sword”, you know. You can learn faster than we did, because there was no access to international journals many, many years ago. It was difficult to get books, which were, you know, in English, in the countries which were not English-speaking countries. So, we appreciate maybe more that investment of time to the knowledge.


Dr. I. Cioanta: That is not easy to go into details and to have patience and study deep, deep down. That is the key to it.


Dr. M. Siemionow: Sure, absolutely.


Dr. I. Cioanta: Do you think there is any current medical trend that makes less sense to you?


Dr. M. Siemionow: Well, bureaucracy.


Dr. I. Cioanta: Ha, ha, ha!


Dr. M. Siemionow: And this is menacing and this is taking too much time and too much effort and really less and less sense.


Dr. I. Cioanta: And it’s everywhere. What topic could you can talk for hours, without any problems?


Dr. M. Siemionow: Well, I think that, yeah it is part of my expertise, of course. Few fields. One is the transplantation, not only human transplantation but also transplantation research, tolerance inclusive studies. The other topic I like is nerve regeneration. And I am a past President of American Society for Peripheral Nerves and I was very much involved in that. And daily I see many patients with carpal-tunnels, because my practice of course has to be not only face transplants, which are expected once in a while or in few years. And the third topic, which was a part of my work for SANUWAVE, it’s on microcirculation and looking directly into the muscle, vessels, and modalities, and everything, to be sure you have actually the possibility of checking what’s going on, after the clinically relevant surgical insult.

Dr. I. Cioanta: So now a personal question - how do you balance work and your private live?

Dr. M. Siemionow: Well, I have a lot of support from my husband and colleagues, of course. And still even now when it comes more to, he will traveling with me and supporting me. He always did, when I was “on call” and you know helping also, taking care of our son. And I did as well, but that’s very important to know that someone is there, who will not, you know, make you feel uncomfortable that you are missing something.


Dr. I. Cioanta: Well, Dr. Siemionow thank you very much for your time.


Dr. M. Siemionow: Thank you so much.


Dr. I. Cioanta: It’s always a pleasure to talk to you, and we are looking forward for all these great things to happen, you know, like we talked into this interview.


Dr. M. Siemionow: Well, I hope also, Iulian, that part of that it will may be the upcoming future with SANUWAVE


Dr. I. Cioanta: Yes, truly we believe that and we want to do that.


Dr. M. Siemionow: Thank you so much.


Keywords: wound care, diabetic foot ulcers, DFU, shockwave therapy, amputation prevention, dermaPACE, chronic wounds, SANUWAVE, PACE Technology, Dr. Maria Siemionow, interview

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