Wound complications in patients with acute lower limb venous thrombosis associated with COVID-19

Abstract

The course of the reparative process in surgical pathology directly depends on hemomicrocirculation, nutrition and oxygen supply in tissues, as well as the activity of lipid peroxidation processes. A novel coronavirus infection can slow down the reparative process and potentiate the development of wound complications. Aim - to study the features of the tissue healing process in patients with deep vein thrombosis of the lower extremities against the background of a new coronavirus infection. Material and methods. 130 patients were monitored: group 1 - 48 patients with acute thrombosis of the veins of the lower extremities, group 2 - 82 patients with acute deep vein thrombosis of the lower extremities, combined with coronavirus infection. Patients underwent thrombectomy followed by plication. On the 2nd, 4th and 7th days, a comprehensive study of the state of the tissues of the area of surgical intervention was carried out to determine the nature and rate of healing, the development of wound complications. Results. In a quantitative analysis of the developed complications on the side of the wound after surgery, it turned out that their number in patients with coronavirus infection was more than 7 times higher (p<0.001). A feature of the wound process as a whole was prolonged lymphorrhea. Cytological signs of impaired tissue healing in the wound area were established. So, in group 2 two days after the operation the number of neutrophilic leukocytes in the wound exudate was 48.2% more than in the group 1, by day 7th - 69.5% more. Weak dynamics of the regenerative-degenerative index was noted. The number of tissue polyblasts in patients of group 2, was 4.2-100.2% lower than those of group 1 at all stages of observation, and lymphoid polyblasts - 47.0-159.1% higher. Patients with coronavirus infection have more significant microcirculatory disorders. According to thromboelastography data, in patients of group 2, an imbalance in the blood coagulation system was registered with a predominance of thrombosis. Conclusion. In patients with acute deep vein thrombosis of the lower limb against the background of coronavirus infection, the wound healing process, which underlies the development of wound complications, slows down. One of the factors that reduce the rate of tissue healing are microcirculation disorders against the background of pronounced disorders in the hemostasis system. The most significant changes in the microenvironment of regenerating structures occur in the first 2-4 days after surgery.