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Welcome to the Wiktor Lab
Arek Wiktor, MD
Research Interests
Dr. Wiktor has over a decade of experience in burn and frostbite surgery, specializing in trauma surgery, critical care, and limb salvation. Research in the Wiktor laboratory focuses on acute burn and frostbite injury. Specifically on burn resuscitation and fluid optimization, hypermetabolic/inflammatory changes including augmented renal clearance and endotheliopathy, PTSD/pain control, and frostbite injury therapeutics.
Active Research Projects
Randomized Trial of Fresh Frozen Plasma Versus Albumin in Acute Burn Resuscitation
Funding: Military Burn Research Program (MBRP) Clinical Translational Research Award, Congressionally Directed Medical Research Programs (CDMRP), MB200032
Severe burn injury results in exaggerated inflammatory response requiring proper fluid resuscitation due to increased capillary permeability. For the past 100 years, colloids, such as fresh frozen plasma (FFP) and albumin, have been given during resuscitations in varying amounts without a consensus as to which product is optimal, specifically, which colloid is optimal for burn resuscitation. Further, recent evidence shows that vascular endotheliopathy such as glycocalyx shedding plays an important role in the pathophysiology of capillary permeability related to burn injury. Correction of this “endotheliopathy” has potential to improve fluid resuscitations and reduce complications. Our objective is to determine the efficacy, safety, and effect on endotheliopathy with FFP versus albumin in critically injured burn patients. Our aims will be to 1) evaluate the total fluids administered in FFP (intervention) and albumin (control) groups for 48 hours, 2) determine overall safety of FFP vs. albumin resuscitation by examining complications rates such as ARDS/fluid overload, and 3) characterize the effects of colloid administration on endothelial dysfunction measuring glycocalyx degradation products such as syndecan-1 in the serum by mass spectrometry. We will conduct a single center prospective randomized trial in critically injured burn patients admitted to our ABA-verified burn center. Upon admission, patients will be screened, consented, and randomized to either FFP- or albumin-based fluid resuscitation.
Prevention and Treatment of Frostbite Infection with Antimicrobial Pharmacokinetic Analysis
Funding: MBRP Joint Program Committee 2/Military Infectious Diseases Research Program (JPC-2/MIDRP) and JPC-6/Combat Casualty Care Research Program (CCCRP), DM220077
There is little scientific evidence regarding the treatment of frostbitten tissues beyond the acute setting. Far less is known about the prevention and treatment of frostbite wound infection. The effect of aloe vera or other alternative topical dressings on frostbite wound microbiology and infection prevention have not been examined. Similarly, antibiotic effectiveness at the tissue level, pharmacokinetic dosing strategies, and examination of augmented renal clearance have not been performed. Our objective is to determine feasibility of long-acting silver dressings in acute frostbite management, and examine modified pharmacologic approaches including long term antibiotics such as the long acting antibiotic dalbavancin which can optimize treatment of frostbite wound infections. Our aims will be to 1) evaluate the microbial effectiveness of long-acting silver dressings (intervention) versus aloe vera (control) groups to study the effect of microorganism growth and evaluate infection prevention, 2) perform a pharmacokinetic and pharmacodynamic (PK/PD) analysis of dalbavancin (a long-acting antibiotic) in blood and various cold-injured tissues to determine safety, efficacy, and optimal dosing, and 3) determine the presence or absence of augmented renal clearance (ARC) with effect on antibiotic PK in cold injury patients. We will conduct a single center prospective randomized trial of silver vs. aloe vera in acute frostbite patients admitted to our burn center. In addition, all patients with clinical infection will be evaluated for dalbavancin antibiotic therapy with subsequent blood and tissue analysis. Finally, all patients will have 12-hour urine collections performed to evaluate presence of ARC.
FROST (FRostbite management multicenter prospective ObServational Trial)
Funding: Military Burn Research Program Department of Defense, HT9425-23-MBRP-CTRA
Severe frostbite injury frequently results in long-term disability and limits quality of life. Both the military and civilian populations are at risk of frostbite injury through living in or deployment to areas impacted by frigid temperatures. More recently, areas not acclimated to cold weather have been impacted by extreme cold and expansions in military deployment to Alaska and other cold-weather regions place new populations at risk of frostbite injury. The dearth of well-conducted large studies has stymied the advancement of frostbite management and failed to support the development of strong guidelines by which to standardize clinical practices. As a result, guidelines in frostbite treatment are lacking and little progress has been made in the treatment of this debilitating disease. We are a participating site in this prospective multicenter observational trial examining novel interventions, triage, and treatment of frostbite injury. The specific aims include: 1) assess the impact of warm ischemia time on early tissue salvage, 2) assess the utility and accuracy of visual assessment of frostbite injury compared to formal perfusion imaging, 3) evaluate the impact of thrombolytics on early tissue salvage, 4) assess the impact of rapid rewarming on early tissue salvage, 5) assess the safety and efficacy of early thrombolytic delivery prior to formal perfusion imaging (angiogram or technetium scan).