DYNAMICS OF CHANGES IN IMMUNOLOGICAL INDICATORS DURING SURGICAL AND LOCAL TREATMENT OF SOFT TISSUE DEFECTS IN MINE-BLAST INJURY

Abstract. The purpose of the work is to establish the dynamics of changes in immunological indicators during surgical and local treatment of soft tissue defects in mine-explosive trauma. Materials and methods. The clinical group consisted of 16 wounded people with gunshot and mine-explosive wounds with damage to the skin and soft tissues of various localizations, who were undergoing inpatient treatment at the SI ‘Zaitsev V.T. Institute of general and urgent surgery of NAMS of Ukraine’. In patients with wound defects of soft tissues due to explosive trauma, the functional activity of indicators of humoral and cellular links of innate and adaptive immunity was studied against the background of the treatment aimed at restoring the skin. Research results. During the local and surgical treatment of patients with wound defects after restoration of the skin, a decrease in the concentration of the C3 component of complement was observed in patients. The activation of neutrophils in oxygen-dependent phagocytosis was determined, which was evidenced by an increase in the phagocytic index and phagocytic number during all periods of examination of patients with skin defects. All patients with injuries at the time of 1 examination revealed a significant decrease in lymphocytes carrying the early activation marker CD3+CD4+CD25+. Later, at the time of the 2nd examination after the restoration of the skin, an increase of this indicator to the reference values was observed. The percentage of engraftment of skin flaps after free plastic surgery was 94%. Conclusions. Thus, at the time of the 1st examination, a pronounced immunoinflammatory process was observed in patients with soft tissue defects due to a mine-explosive injury, which was manifested in an increase in the indicators of the humoral and cellular links of innate immunity: an increase in the C3 component of complement and an increase in the number of phagocytizing neutrophil granulocytes, which required targeted immunocorrection in order to clean the wound and improve regenerative processes. In the victims, a pronounced imbalance of regulatory T-lymphocyte subpopulations CD3+CD4+CD25+, CD3+HLA-DR+ and CD3+CD4+CD28+ was observed at the time of the 1st examination, which indicates immunological insufficiency of the cellular link of adaptive immunity with subsequent activation of these indicators. In the process of treatment, the level of markers of early activation positively increased and the marker of late activation of T-lymphocytes decreased, which can be considered as an effect of immunocorrection of the treatment. Local and operative treatment of wound defects of soft tissues aimed at restoring the skin in optimal terms contributed to the normalization of indicators of non-specific resistance, humoral immunity and cytokine spectrum.