The effect of mechanical skin damage on manifestations of endotoxicosis and immune response under the influence of skeletal trauma complicated by acute blood loss and PRP-therapy effectiveness

Abstract

Summary. The frequency of emergencies in both peacetime and wartime conditions has significantly increased in recent years. Under those circumstances, severe multiple and combined traumas, caused by skeletal trauma, acute blood loss and massive soft-tissue and skin damage, predominate among the various kinds of injuries. The role of mechanical skin damage in the course of severe trauma is insufficiently presented in the existing studies and literature. There are no data on the effectiveness of platelet-rich plasma grafts (PRP-therapy) under those conditions, which can greatly accelerate the regeneration of damaged soft tissues and skin, and thus inhibit the manifestations of systemic disorders, in particular endotoxicosis and immune responses. The aim of the study – to establish the effect of mechanical skin damage on the dynamics of indicators of endogenous intoxication and immune responses under the influence of skeletal trauma complicated by acute blood loss and evaluate the PRP-therapy effectiveness. Materials and Methods. The experimental studies were performed on 186 nonlinear white male rats weighing 180–200 g. In the first experimental group, the animals were simulated a mechanical damage of skin (a skin flap of 2×2 cm on the back of the animal was cut). The animals of the second experimental group were subjected to a skeletal trauma complicated by acute blood loss. In the third experimental group, these lesions were combined. In the fourth experimental group, the animals with combined trauma were administered an intradermal injection of 0.1 ml of platelet-rich plasma in wound edges. After 3, 7, 14, 21 and 28 days of trauma infliction, the animals were removed from the experiment. Contents of middle molecular weight (MMW280) fraction and circulation immune complexes (CICs) were measured in serum. The control group consisted of intact animals. Results. The research findings have shown that the infliction of isolated damage to skin is accompanied by the accumulation of the MMW280fraction and CICs in serum, the contents were higher than control values at all experimental periods reaching their maximum after 7 days and starting to increase again after 21 days. The pattern of the dynamics of the studied indicators in conditions of skeletal trauma complicated by acute blood loss was similar, but with greater amplitude. A combined trauma model resulted in an even greater increase in the intensity of endogenous intoxication and immune responses at all experimental time points. The administration of the PRP-therapy led to the decrease in the contents of MMW280 fraction and CICs in serum of rats with the combined trauma model starting from 7thday and 21st day of the experiment, respectively, as compared to the animals with the trauma model without correction. Conclusions. The infliction of damage to skin provokes the significant increase in the contents of MMW280 fraction and CICs in serum and can enhance the endogenous intoxication and immune responses in the presence of skeletal trauma complicated by acute blood loss. Intradermal administration of allogeneic platelet-rich plasma injection under these conditions leads to the decrease in the contents of MMW280 fraction and CICs as compared to the untreated animals with trauma model