1Federal State Budgetary Establishment «State Scientific Research Test Institute of the military medicine of the Russian Federation Defense Ministry»
2Military Medical Academy named after S.M. Kirov
Background. In injury surgery, the protective and regenerative properties of hyaluronic acid (HA) gels have become widely used. Despite this, the effectiveness of early local application of HA on the regeneration of skeletal muscles in the area of damage during prolonged static compression of soft tissues has not been sufficiently studied at present.
Objective. To study the sanogenetic mechanisms of early correction of local soft tissue injuries with hyaluronic acid in compression injury.
Materials and methods. The study was performed on 66 male Wistar rats, which were divided into 3 groups before the experiment: the main group (n=28), the comparison group (n=28) and the intact group (n=10). Animals of the main and comparison groups were subjected to mechanical compression of the soft tissues of the thigh with a compression force of 10-12 kg/cm² and a compression duration of 7 hours. No compression injury was applied to intact animals. After 3 hours, the animals of the main group were injected locally with a 1.75% solution of hyaluronic acid in a volume of 2.0 ml/kg, the animals of the comparison group did not receive local treatment. 3, 7, 14, and 28 days after the end of compression, we measured the femoral circumference, biochemical parameters (myoglobin, potassium), determined the state of microcirculation and soft tissue metabolism, and performed a histomorphological study of skeletal muscles in the area of injury.
Results. In the early (3-7 days) and intermediate (14 days) post-compression periods in animals after local administration of HA, a less pronounced swelling of the soft tissues of the thigh was noted, a decrease in myoglobin by 20-69% (p<0.05) and potassium by 34% (p<0.05) was observed, a less significant increase in the level of pro-inflammatory cytokines in the blood, increased perfusion and metabolism in the area of compression (increase in the coefficient of variation of the microcirculation index (Kv) by 25-43% (p<0.05) and the index of oxygen exchange efficiency (ОЕЕ) - by 93-95% (p<0.05). In the late compression period (28 days) after the use of HA, an increase in the profile of anti-inflammatory IL-10 oxygen exchange (increased OEE by 87% (p<0.05), less pronounced post-traumatic atrophy of skeletal muscles in the area of damage. The proportion of necrotic muscle fibers by the end of the observation period was reduced by 30% (p<0.05), and the area of newly formed elements of skeletal muscle tissue increased by almost 1.5 times for (p<0.05) compared with animals without local treatment.
Conclusion. Early local correction of soft tissue damage with hyaluronic acid stops microcirculatory and metabolic disorders, which inhibits the progression of the pro-inflammatory reaction, limits tissue necrosis in the area of compression, promotes active neomyogenesis without the formation of a pronounced connective tissue regenerate.
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