Еvaluation of the effectiveness of surgical treatment in patients with extensive burns based on the studied immune status

Background. The concept of comprehensive treatment of burns is based on active surgical tactics aimed at removing necrotic tissues and restoring the integrity of the skin at earlier terms, which is essential for the prevention of purulent-septic complications of burn disease. Timely diagnosis of the development of infectious septic complications and immunodeficiency conditions based on the immune status monitoring is an urgent task of comprehensive, including surgical, treatment of patients with extensive burns. Aim. To evaluate the effectiveness of surgical treatment in patients with extensive burns based on a comprehensive analysis of the immunological study results. Materials and methods. The single-center retrospective non-randomized study included 100 patients with an average burn area 47.7±1.5% of the body surface (b.s.). Of these, deep burns averaged 16.5±1.7% b.s. All patients underwent comprehensive treatment based on clinical recommendations in the field of surgery (combustiology), including surgical necrectomy, local drug treatment of burn wounds using modern wound coverings and skin grafting to close wounds. The immune status was monitored in 100 patients using flow cytometry, turbidimetry and chemiluminescence techniques starting from the moment of admission to the Burn Center; in 55 of them the immune status was monitored in dynamics on the 10th and 30th days of treatment. The immune status parameters of 30 donors were used to compare the patients’ data. Results. Reliably significant (p0.05) alternative changes were identified in 15 key immune markers: leukocytes, band neutrophils, total lymphocytes, blood leukocyte shift index, leukocyte intoxication index, CD4+/CD8+, CD21+, CD64+, HLA-DR+ monocytes, HLA- DR+ lymphocytes, CD25+, CD16+, CD56+, IgG and IgM. Complex treatment of burn disease, prevention and treatment of its complications, resulted in a consistent normalization of the immune status in 43 (78%) patients in 40.8 ± 2.9 days after the burn injury; these patients had been exposed to timely removal of non-viable tissue, their burn wounds had been prepared for plastic closure using modern wound dressings and water-soluble ointments, autodermoplasty had been performed as early as possible. Simultaneously, positive changes in key immune markers with relief of endogenous intoxication and infectious-inflammatory reaction, normalization of antimicrobial potential in general allowed effectively continuing surgical treatment to restore the skin. Conclusions. The results obtained based on the first used multiparametric panel of immune markers do not only emphasize the importance of active surgical tactics in providing specialized medical care to victims with extensive burns, but also allow for its timely correction at various stages of complex treatment in severely burned patients.