ULTRASTRUCTURAL CHANGES OF MONONUCLEAR MACROPHAGES UNDER THE ACTION OF OZONE THERAPY AND LOCAL APPLICATION OF AUTOLOGOUS PLATELET-RICH PLASMA IN THE TREATMENT OF DIABETIC FOOT SYNDROME

Abstract

Objective – to study the character of ultra- structural changes in the tissue macrophages under the eff ect to complex of accessory factors promoting reparative process activation in the wound: ozone therapy, local application of autologous platelet-rich-plasma.Materials and methods. The patients were divided into three groups. The 1st group included 23 (32,85%) individuals who were treated by means of ozone therapy. The 2nd group included 23 (32,85%) patients treated by means of local platelet-rich plasma (PRP) therapy. The control group included 24 (34,28%) individuals who received a complex of therapeutic measures according to the generally accepted method. Surgery or all the patients was performed with maximum saving of the vessels in the plantar region, and the local treatment included topical vacuum therapy in the amount of 5-6 procedures. Electronic- microscopic examination used the fragments of tissue from the wound surface preserved in 2,5% glutaraldehyde solution on phosphate buff erі (рН – 7,2-7,4), followed by further processing in 1% anhydride solution. The material was dehydrated in increasing concentration alcohols and placed into araldite. The morphological structures were contrasted with a concentrated solution of uranyl acetate in the process of dehydration, and on the sections – with lead citrate. The sections 40-60 nm thick obtained by means of ultratome УМТП-3 were examined under the electron microscope TESLA БС-500. The specimens for examination were taken in the patients during dressings on the 7, 14 and 21-23 days of treatment. The dynamics of changes in the tissue macrophages was conducted by means of Astaldi principle generalizing percentage evaluation. It is a semi-quantitative method considering distinctive cytological changes determined in the similar amount of the cells examined (tissue macrophages).Results. Stimulation of the macrophage functional activity under the eff ect of ozone with destructive changes found in the cells without necrotizing damage was found to be explained by apoptosis mechanism involved as a positive factor in the regulation of local homeostasis at the completion of infl ammatory (exudative) phase of the wound process. Activation of phagocytic possibilities of the tissue macrophages with local application of autologous platelet-rich plasma occurs without any signs of apoptosis prevailing, and it is indicative of stimulation of their functional activity by antigenic or enzymatic mechanisms stimulating their functional activity.Conclusions. Stimulation of macrophage functional activity under ozone eff ect and availability of destructive changes in the cells without necrotizing damage can be explained by the involving of apoptosis mechanism as a positive factor in the regulation of local homeostasis at the completion of infl ammatory (exudative) phase of the wound process. Activation of phagocytic possibilities of the tissue macrophages with local application of autologous platelet-rich-plasma occurs without any signs of apoptosis prevailing, and it is indicative of stimulation of their functional activity by antigenic or enzymatic mechanisms stimulating their functional activity.Prospects of further studies. The results obtained confi rm and determine further necessity to conduct search innovations in the treatment of diabetic foot syndrome using the factors of physical and biological eff ect directed to the activation of a reparative process in the wound.