Gorianikova I. Pathological anatomy of reparative processes at application of TUTOPLAST® in primarily infected wounds.

Object of the study: Bioimplantat TUTOPLAST®. Purpose of the study: Comparative morphological and immunological investigation of the features of ingrowth of low-immunogenic bioimplantat TUTOPLAST® and sysnthetic material MARLEX® at plastic surgery for defects of the anterior abdominal wall in a sterile and infected wound followed by substantiation of indications for the use of these plastic materials. Methods of the study: Histological, histochemical, immu-nohistochemical as well as immunological, x-ray and laboratory methods. Theoretical and practical results: The obtained findings of comparative morphological and immunological investigation about the features of ingrowth of low-immunogenic bioimplantat TUTOPLAST® and sysnthetic material MARLEX® in aseptic and infected wounds of the anterior abdominal wall allowed to suggest some practical recommendations aboutthe use of these plastic materials. Bioimplantat TUTOPLAST® is a good plastic material and can be used in tratment of abdominal hernias at large defects in aponeurosis as well as in other plastic operations. The study showed that due to absence of infectious complications and immunological side-effects in the recepients, including rejection reactions, it was not necessary to administer immune-correcting therapy aimed at inhibition of rejection reaction. Preference should be given to bioimplantat TUTOPLAST® as an aimmunogenic and durable material. Novelty: For the first time comparative data about the morphology of ingrowth of bioimplantat TUTOPLAST® and sysnthetic material MARLEX® in aseptic and infected wounds of the anterior abdominal wall are presented. It was established that when TUTOPLAST® was used in an aseptic wound, infectious complications and immunological side-effects of the recepient, including rejection reaction, were absent. It was shown that infected implantation bed decelerated ingrowth of TUTOPLAST® which caused healing with secondary intention. It was established that alloplastic material MARLEX® due to its antigenically foreign nature could cause chronic granulomatous inflammation in an aseptic wound and rejection reaction in an infected wound. The study showed that the use of TUTOPLAST® in a sterile wound results in activation of collagen production (both interstitial, I, III, and IV) in epiedermodermal and vascular basal membranes. The use of MARLEX® did not provide increase in collagen formation in the wound. It was shown that aimmunogenic bioimplantat TUTOPLAST® provided stable development of main links of the immune reaction while the use of MARLEX® caused weakening of macrophagal reaction and increase of plasmatization in the wound. For the first time it was established that increase in the level of endothelin synthesis by the endothelium bed of the granulation tissue vessels was a consequence of disorders in collagen IV synthesis in the basal membranes of the vessels. It was shown that surgical repair of hernia with bioimplantat TUTOPLAST® did not cause negative immune reactions in the organism of therecepient. Degree of introduction: The findings of the recearch were introduced to the work of surgery department of City Hospital No. 2 (Kharkiv) as well as teaching process of Pathology Department of Kharkiv State Medical University. Area of application: Medicine, surgery.