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

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Abstract

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 (p<0.05) 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.

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About the authors

Maria N. Kozlova

A.V. Vishnevsky National Medical Research Center of Surgery

Author for correspondence.
Email: mnkozlova@rambler.ru

Ph.D., Senior Researcher at the Department of Thermal Lesions

Russian Federation, Moscow

Andrey A. Alekseev

A.V. Vishnevsky National Medical Research Center of Surgery; Russian Medical Academy of Continuous Professional Education

Email: alexseev@ixv.ru

M.D., Professor, Head of the Burn Center, Deputy Director

Russian Federation, Moscow; Moscow

Vladimir M. Zemskov

A.V. Vishnevsky National Medical Research Center of Surgery

Email: arturrego@yandex.ru

M.D., Professor, Chief Researcher at the Clinical Diagnostic Laboratory

Russian Federation, Moscow

Alexandr E. Bobrovnikov

A.V. Vishnevsky National Medical Research Center of Surgery; Russian Medical Academy of Continuous Professional Education

Email: doctorbobr@mail.ru

M.D., Associate Professor, Head of the Burn Department, Professor of the Department of Thermal Injuries, Wounds and Wound Infection

Russian Federation, Moscow; Moscow

Nadezhda S. Shishkina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: nadya-vesy@mail.ru

Junior Researcher at the Clinical Diagnostic Laboratory

Russian Federation, Moscow

Anna N. Kulikova

A.V. Vishnevsky National Medical Research Center of Surgery

Email: shinshila72@mail.ru

Doctor of Clinical Laboratory Diagnostics at the Clinical Diagnostic Laboratory
Russian Federation, Moscow

Valentina S. Demidova

A.V. Vishnevsky National Medical Research Center of Surgery

Email: demidova@ixv.ru

M.D., Head of the Clinical and Diagnostic Laboratory

Russian Federation, Moscow

Marina S. Solovieva

A.V. Vishnevsky National Medical Research Center of Surgery

Email: solovevama@ixv.ru

Ph.D., Senior Researcher at the Clinical Diagnostic Laboratory

Russian Federation, Moscow

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2. Fig. 1. Patient D., 25 years old. Type of burn wounds upon admission to the Burn Center with the diagnosis: Flame burn of the torso, upper and lower extremities, I-II-III degree, 50% of the body surface (III degree - 35% of the body surface).

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3. Fig. 2. Granulocyte content (%) with CD 64+ expression (ordinate axis) in severely burned patients upon admission to the Burn Center in comparison with healthy donors.

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4. Fig. 3. The content of HLA-DR+ monocytes (%) (ordinate axis) in severely burned patients upon admission to the Burn Center in comparison with healthy donors.

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5. Fig. 4. IgG and IgM immunoglobulin content (g/l) (ordinate axis) in severely burned patients upon admission to the Burn Center in comparison with healthy donors.

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6. Fig. 5. Tangential surgical necrectomy of burn wounds of the lower limb with a circular electrodermatome Surgical necrectomy followed by autodermoplasty of burn wounds of the lower limb.

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7. Fig. 6. Free autodermoplasty of granulating wounds of the lower limb with a split perforated 1:6 autodermal graft.

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Copyright (c) 2025 Kozlova M.N., Alekseev A.A., Zemskov V.M., Bobrovnikov A.E., Shishkina N.S., Kulikova A.N., Demidova V.S., Solovieva M.S.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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