Selenase® In Plastic Surgery
Scientific information On
Plastic Surgery
Causes Of Ischaemia:
- Complete (no perfusion) unpredictable ischaemia, micro and macro amputations (fingers, arms, legs etc.)
- Incomplete (some residual perfusion) unpredictable ischaemia, contusions, avulsions
- Predictable ischaemia, free flaps (pedicled flaps, muscles, fascia, adipose tissue, intestine)
- Special case: burns
Risks After Reperfusion:
- Microthrombosis
- Inflammation
- Necrosis
- Death of tissue / amputation
Conventional Measures to Prevent SIRS:
Surgical:
- restoration of patency
Pharmacological:
- anticoagulants (heparin, NSAR), thrombolytic substances, anti-inflammatory drugs, free radical scavengers, vasodilators (Ca-channel inhibitors), immunomodulators
Physical:
- application of cold before reperfusion, heat treatment after completion of anastomoses
- Poor efficacy
Data on Selenium (Selenite):
- In animal models: Ebselen derfers arterial and prevents venous thrombus formation [Lindenblatt et al. Thromb Haemost 2003; 90: 882-892]
- In clinical studies: selenite modulates pulmonary infection rates after major burns and leads to an increase in selenium under the skin [Berger et al. Am J Clin Nutr 2007; 85: 1293-1300.]
Possible Actions of Selenium/Selenase® Supplementation:
- Prevention or minimisation of cell death after reperfusion
- Conservation of the tissue / body part
- Minimisation of “after burning” in burns
Suggested Timing And Dosage For Selenium Supplementation:
| Time point | Dosage |
|---|---|
| Pre-operative bolus | 1000 g Se as selenase® solution for injection |
| Intra-operative | 1000 g Se/24h as selenase® solution for injection |
| Post-operative | 1000 – 500 g Se/d as selenase® solution for injection |
Information sheet on PLASTIC SURGERY, biosyn Arzneimittel GmbH, RSi 2008. According to a lecture given by Prof Dr med H Homann, Thieme Workshop 2008 entitled “Ischaemia and reperfusion an interdisciplinary challenge”. For personal use only.
Abbreviated Prescribing Information
selenase® 100 micrograms, solution for injection (50 micrograms/ml) selenase® 500 micrograms, solution for injection (50 micrograms/ml)
- Active ingredient: sodium selenite pentahydrate.
- Composition: Each 2 ml ampoule/10 ml injection vial contains 100 micrograms/500 micrograms selenium as 333 micrograms/ 1.66mg sodium selenite pentahydrate (Na2SeO3 x 5H2O), corresponding to 50 micrograms/ml.
- Excipients: Sodium chloride, hydrochloric acid, Water for Injections.
- Indication: Proven selenium deficiency that cannot be offset from food sources.
- Posology and Administration: selenase® solution for injection is administered as an intramuscular or intravenous injection at a daily dose of 100 200 g (1.27 2.53 mol) selenium. If necessary, this dose can be increased to 500 g (6.33 mol) for a typical adult. No dosage adjustment is required for paediatric, renal or hepatic impairment patients.
- Contraindications: Selenosis.
- Interactions: Ensure that the pH value does not fall below 7.0 and that the solution is not mixed with reducing substances (e.g. vitamin C).
- Pregnancy and Lactation: There are no data from the use of selenase® in pregnant or lactating women.
- Undesirable Effects: None known to date when used as directed.
- Overdose: Counter measures include gastric lavage, forced diuresis, dialysis or administration of high doses of vitamin C.
- Pharmaceutical Precautions: Store below 25ºC.
- Legal Category: POM.
- Presentation: Cartons containing 10 x 2ml ampoules / 10 x10ml glass vials for single use.
- MA Numbers: PL 20437/0003, PL 20437/0004.
- MA Holder: biosyn Arzneimittel GmbH, Schorndorfer Str 32, D-70734 Fellbach, Germany.
- Date of Preparation: November 2004