We can now safely say that the feet reconstruction surgery has been successful. The patient has been through three different operations. He had his feet amputated first. No as high as it usually the case, which is just below the knees, but very close to live tissue. This would not have been possible without the innovative ideas and determination of Adam Domanasiewicz, PhD. "He had a fourth degree frostbite. All tissues, including the bones, were attacked by necrosis. I was asked for advice several weeks after Grzegorz had been admitted to hospital. There was no chance we could save his feet," says the doctor.
He also says that awareness must be raised for medical staff to realise that amputation is not the only way to deal with severe frostbites. Frostbitten tissues are suspended, as it were, and necrosis, which occurs only after they begin to defrost, takes the form of infarct, which is exactly the same as a heart attack. Since all irreversible changes arise after defrosting tissue, there might be a chance of saving the limb if the methods that help fighting the stroke or myocardial infarction were applied. "This is what we call anti platelet, anticoagulant and trombolic treatment. The therapy helps to dissolve the clots that form in defrost tissue," adds Dr Domanasiewicz.
As the President of the Polish Medicine and Mountain Rescue Service Society, Adam Domanasiewicz is keen to promote his method of treatment among the doctors. Measures as drastic as amputation would no longer be necessary in some cases. "There is no modern procedure to treat frostbites at the moment. We are only dealing with the final product, that is, necrosis. The only method in use is amputation. So the whole point is to prevent necrosis," adds the surgeon.
For Grzegorz Włodecki, it was too late to benefit from this state-of-the-art treatment procedure. However, Dr Adam Domaniecki did everything in his power for the patient to stand on his own two feet. He came up with a different idea to save his limbs, namely self-transplantation. He used pieces of muscle, vessels and nerves as well as skin taken from the patient's thighs and back to partially reconstruct the amputated feet. The patient can now walk without any prostheses. The whole procedure took several months to complete. The patient has a sense of feeling in his legs, and he can also use special orthopaedic insoles instead of prostheses.
The doctors' mission has now been accomplished. The patient now has to practice a lot to enhance his feet. He and Dr Domanasiewicz went shopping to make the whole task a little easier. "I promised Grzegorz a new pair of army boots. He's a Depeche Mode fan, so no other option was possible. And I have managed to keep my word."
The doctor adjusted the shoes in such a way that the patient can now use special orthopaedic insoles and metal sole stiffening.
Grzegorz has now to do his part for the treatment to be successful.
Modern frostbite treatment methods will be discussed in detail at the third edition of Przypadkimedyczne.pl Conference, which is to be held on 8th October in Wroclaw. Some of the speakers at the conference include: Maria Semyonov (USA, first face transplant) and Professor Adam Maciejewski (Poland, Gliwice, first lifesaving face transplant). Read more at www.przypadkimedyczne.pl.
Adam Domanasiewicz
He is Lower Silesia's first specialist in hand surgery and also an expert in general surgery, emergency medicine and Gamow medicine. Hand surgery is a unique specialization in Poland (10 specialists in the country), combining the skills of orthopaedics, plastic surgery, vascular surgery, neurosurgery and general surgery. Prospective hand surgeons have to pass a specialisation exam organised by the FESSH to obtain internationally-approved qualifications. A PhD in Medicine, he is a former student and collaborator of Professor Ryszard Kocięba and Professor Jerzy Jabłecki; former Head of the Emergency Department at the Saint Hedvig Hospital in Trzebnica, Senior Assistant at the Department of General Surgery and Hand Surgery in Trzebnica, a member of many scientific societies, including the European Federation of Hand Surgery, member of the Board at the International Hand Transplantation and Complex Tissue Transplantation Society, an honorary member of the Romanian Plastic Surgery Society, Polish Hand Surgery Society, Traumatology Society, Association of Polish Surgeons and Emergency Medicine Society. He is also the President of the Polish Medicine and Mountain Rescue Service Society. He has also taken part in Poland's first hand transplants and performed many replantation surgeries and a number of innovative hand and reconstructive surgeries. He has authored research papers and scientific articles and won ,any awards for his medical activity. In 2014 he received the Golden Cross of Merit from the President of the Republic of Poland. A long-standing member of medical staff at the Saint Hedvig Hospital in Trzebnica, Adam Domanasiewicz is now working at the Wroclaw University Research Hospital.
