Objective: to study the peculiarities of the state of the lower extremities venous system in patients with complicated diabetic foot syndrome (DFS).

Materials and methods. The study group – 106 patients with type 2 diabetes mellitus (DM) and purulent-necrotic complications of DFS treated in the surgical department of the St. Petersburg State Medical Academy in 2009-2014. 30 preparations of the lower extremities obtained as a result of amputations in patients with purulent-necrotic complications of DFS and from corpses after autopsy. Conducted a macroscopic study of the lower extremities veins with a visual assessment of the changes and microscopic examination with the staining of histological preparations with hematoxylin and eosin, according to Van Gieson and Masson; ultrasound duplex examination (ultrasound) of the lower extremities veins in patients with DFS according to the standard protocol.

Results. Macroscopic evaluation in 90.0 % of cases revealed an excess of extracellular fluid (edema) of the extremities tissues. An analysis of the ultrasound findings of the lower extremity veins demonstrates the presence of lymphostasis in patients with diabetes in 83.0 %. In the overwhelming majority of preparations of vessels of the extremities with DFS (97.0%), a segmental expansion of the venous lumen was detected. Such a change can be the cause of cases detected during ultrasound in 60.0% and 73.0%, respectively, of dilatation of the veins and valvular insufficiency. In both morphological and ultrasound studies in no more than 15.0% of cases, the expansion sites were in the superficial veins, and fragments of an increase in the diameter of the lumen of the deep veins were found in 60.0% of patients, which demonstrates the likely difference in the nature of changes in the veins in diabetes and with varicose veins. In macroscopic and then histological studies, pronounced intramural and parabasal fibrosis of venous vessels was found in 37.0 0% and in 67.0 0% of cases, respectively. A rather specific feature to characterize the lesion of the venous system in diabetes is an increase in sonographic density of paravasal tissues, especially around the veins of the deep system (about 35.0% of observations). The findings of the ultrasound study describe the incompressibility of a vein or a decrease in its elasticity in the absence of data on the presence of a local thrombus, signs of current or resolved phlebothrombosis in 29.0% of cases in patients with DFS, which exceeds the general population frequency of this pathology even by the highest estimates of researchers. A morphological study of blood clots in venous vessels was found in 57.0% of observations, which may be due to the clinical insignificance or difficulty of visualizing small parietal thrombi and blood clots of small diameter venous vessels, but it confirms both complex disorders of the hemostatic system in diabetes and changes in venous walls predisposing to intravascular thrombosis.

Conclusion. Patients with purulent-necrotic complications of DFS in most cases have signs of damage to the lower extremities venous vessels, it is specific. Standard duplex ultrasound can detect these changes.

Object. To assess the effectivity and safety of different tibiocalcaneal arthrodesis types in treatment of patients with Charcot ankle deformity depending on disease severity.

Materials and methods. We have analyzed the outcomes after treatment of 16 patients with diabetic neuropathic ankle arthropathy (Charcot ankle) at the stage of septic complications in bones of ankle and subtalar joints. The observation period was more than 1 [1–3] year. Ilizarov fixator for TCA was used in 8 cases; internal fixation with cannulated screws was applied in 8 cases.

Results. In the early periods (up to 1 month from the operation) no complications were revealed. Complications in later terms developed in 4 patients: three with internal fixation and one with external.

Conclusion. In our opinion, when choosing foot fixation tactics for heel-tibial arthrodesis, risk groups should be considered stage D according to Rogers classification and stage 3 according to Wagner classification, and after resection of bones in these patients external fixation is preferable. In the remaining stages, internal fixation is advisable because of the patient's higher quality of life and shortening of the rehabilitation period.

Objective. Development of a new method for preparing an skin graft to hypoxia conditions in a recipient wound by tissue stretching of the donor site.

Materials and methods. Scientific hypothesis: dosed tissue stretching and localized circulatory compensated hypoxia resulting in this increase the concentration of cytokine HIF-1α in the area of distracted skin graft. The experiment was performed on 18 white outbred male rats. The level of local circulatory compensated hypoxia was monitored by using laser Doppler flowmetry. An enzyme immunoassay was used to determine the concentration of cytokine HIF-1α in tissue. In the clinical stage of the study, the results of treatment in 9 patients – main group (split-skin grafting developed by the original method) were compared with the results of treatment in 10 patients – control group, who underwent plastic closure according to the traditional method.

Results.The experiment revealed a statistically significant difference between the concentration of cytokine HIF-1α in the intact and disractablegraft, which was confirmed by the results of a clinical study.In the group where split-skin grafting was performed according to the traditional method (control group), the graft engraftment area was (Me [Q1; Q3]) 71.0 [65; 78] %, in the main group – (Me [Q1; Q3]) 87.0 [79; 95] % (p = 0.0003).

Conclusion. It is advisable to use a compensated reduction of microcirculation in a tissue subjected to dosed tissue stretching to train split-skin graft for hypoxia conditions.

The article presents the results of a prospective, single-center observational clinical trial, in which biomarker levels were compared in patients with sepsis.

Objective: to evaluate the dynamics of the level of presepsin, procalciotonin and C-reactive protein in two groups - the dead and the surviving patients with sepsis.

Materials and methods. The study consistently included 41 patients with a diagnosis of sepsis (based on the concept of "Sepsis-3"), divided into two groups: group 1 (21 people) – survivors, group 2 (20 people) – dead. Patients in both groups received conventional intensive therapy for sepsis. In addition to the standard laboratory and instrumental examination, patients in the dynamics were monitored for the level of presepsin, procalcitonin, C-reactive protein.

Results. The average level of presepsin in group 1 and group 2 was 1718.00 and 3266.50 pg/ml, respectively, with half of the values being within (Me (25.75) 1021.00–3231.00 and 1618.50–7469.00 pg/ml. The average level of procalcitonin in group 1 and group – 0.995 and 4.465 ng/ml, respectively, while Me (25.75) 0.49–4.44 and 1.625–19.30 ng/ml. The average level of C-reactive protein in group No. 1 and group No. 2 is 95.5 and 215.0 mg/l, respectively, with Me (25.75) 64.00–155.00 and 155.00–264.00 mg/l. When comparing the values of biomarkers in the two groups of patients, significant differences were found (p-value for presepsin, procalсitonina and C-reactive protein are, respectively 0.000008, 0.000242, 0.0000001).

Objective. The aim of the study is to develop a technique of potentiating traditional multimodal anesthesia with contact laser exposure to the body in the red range (650 nm) in patients with critical lower limb ischemia (CLI).

Materials and methods. Multimodal anesthesia in the main group was performed with the potentiation of modern laser technology in 70 to 94 years old 35 patients [7 (20.0 %) women and 28 (80.0 %) men] with CLI and associated diseases. As a comparison group, a retrospective group of 23 patients was selected who underwent a high amputation of the lower extremities without potentiation of multimodal anesthesia with laser blood radiation. Multimodal anesthesia was additionally potentiated with quantum hemotherapy sessions. Sessions were carried out using a fifth-generation semiconductor contact laser irradiation of blood LASPOT (PRC) in the form of a wristwatch with an additional effect on the acupuncture points Nei-Guan, Tun-li – the heart meridian, connection with the inner world, Ling-dao – the meridian hearts, the road of the spirit. The first session was performed to patients before surgery — a duration of 15 minutes; the second — during surgery — a duration of 30 minutes.

Results. The obtained data on the shifts of peripheral hemodynamic parameters at the stages of surgical interventions in patients of both groups practically did not demonstrate significant differences from the baseline values, reflecting the adequacy of the degree of anesthesiological protection. In patients of the main group, central hemodynamic indices: the cardiac index (CI) significantly increased from 2.81 ± 0.49 to 3.15 ± 0.58 (p < 0.05) l/min∙m2, and total peripheral vascular resistance (TPVR) decreased from 1587.5 ± 494.3 to 1492.7 ± 427.8 dyn∙s∙cm-5. In patients of the comparison group, CI increased during surgery from 2.83 ± 0.53 to 3.02 ± 0.35 l/min∙m2, and at the end of the operation it returned to baseline. Potentiation of multimodal anesthesia with modern laser technologies in patients of the main group made it possible to reduce during surgical interventions the average dose of fentanyl, which was 0.98 ± 0.12 mcg/kg/h, while in patients of the comparison group, the consumption of fentanyl was 3.28 ± 0.18 mcg/kg/h (with traditional combined general anesthesia, the flow rate of fentanyl during surgery is on average 5–12 mcg/kg/h or more).

Conclusion. The method of potentiation of the traditional scheme of general combined anesthesia with optical radiation of the red range (650 nm) allows to achieve more pronounced effects of hemodynamic control, makes it possible to reduce the dose of fentanyl, reduce the pharmacological load on the operated patient.

The article presents a clinical, pathological and anatomical case of an extremely rare form of necrotizing infection as a metastatic suppurative lesion in salmonellosis in a patient with diabetes mellitus. The complexities of the differential diagnosis and diagnosis is discussed.