Objective: to evaluate the results of specialized treatment of uncomplicated and complicated trophic ulcer (TU) and osteomyelitis (OM) of diabetic osteoarthropathy (DOAP).
Materials and methods. The results of treatment in 114 patients (127 feet) with DOAP were analyzed: There were 52 (45.6 %) men, 62 (54.4 %) women. The type 1 diabetes mellitus (DM) was diagnosed in 36 (31.6 %) patients (average age 43.0 years old); type 2 diabetes – in 78 (68.4 %) people (average age – 58.0 years old). The acute and subacute stages of DOAP were detected in 55.9 % of cases, chronic – in 44.1 % of cases. The defeat of the middle part of the foot prevailed in 66.9 % of cases. Patients are ranked by the University of Texas classification. DOAP without TU – 71 (55.9 %) cases, with TU – 56 (44.1 %) observations. Stage BIII (OM) – 22 (17.3 %) cases: 8 (6.2 %) – in the subacute stage of DOAP, 14 (11.2 %) – in the chronic stage of DOAP. The examination protocol for DOAP included clinical data (+ sounding of the adjacent bone in TU), thermometry, radiography, and magnetic resonance imaging (MRI) of the feet, as well as laboratory data. A diagnostic algorithm has been developed for the optimal choice of tactical decisions in case of DOAP (TU–/OM–) and DOAP (TU+/OM+).
Results. 80 patients were treated on an outpatient basis under the supervision of a podiatrist. Patients with acute or subacute DOAP (TU−/OM−) received conservative treatment in the form of unloading the limb using an individual discharge bandage until the transition to the chronic stage. In the chronic stage of DOAP (TU–/OM–) recommended the manufacture of complex orthopedic shoes for an individual block. In addition to the correction of hyperglycemia, patients with DOAP (TU+) (AI, AII, BI) used local treatment in accordance with the stage of the wound process. 34 patients (BII, BIII) were treated in a hospital. 27 patients of these underwent surgical procedures, osteonecrectomy, 7 patients underwent arthrodesis. All patients with DOAP (TU–/OM–) (n = 71) limb saved. With DOAP (TU+/OM+) (n = 56): 8 (14.3 %) people – the result is unknown, 7 (12.5 %) patients – retention of TU, 35 (62.5 %) patients – complete epithelization, 2 (3.6 %) cases – small amputations, 4 (7.2 %) – high amputations.
Conclusion. Differentiated specialized treatment of uncomplicated and complicated by trophic ulcers or osteomyelitis DOAP in its various clinical stages made it possible to avoid high amputation in 96.6 % of cases.

Object. to optimize antibacterial therapy in patients with coloproctological profile with purulent-septic complications.

Materials and methods. A one-center intervention study with historical control was conducted. The intervention began in January 2017, when in the hospital FSBI «N. I. Pirogov National Medical Surgical Center» Russian Ministry of Health introduced strict monitoring of compliance with the protocols of empirical antimicrobial therapy. The study included 62 patients who underwent antibacterial therapy after operations on the colon and rectum in 2016–2017. Patients were divided into two groups with respect to the beginning of the intervention: 2016 – comparison group (A), 2017 – main group (B).

Results. There was a slight decrease in the total consumption of antibacterial drugs in coloproctological patients from 823.0 to 691.0 Defined Daily Dose (DDD, established daily dose), as well as the average consumption of antibiotics per patient from 26.5 to 22.3 DDD. An increase in the number of cases of compliance with the approved protocol of empirical antimicrobial therapy (AMT) was revealed from 32.3 % in group A to 67.7 % in group B, p = 0.01. The frequency of adequate empirical antibiotic prescribing increased from 71.0 to 93.5 %, p = 0.042. A significant increase in the frequency of de-escalation of AMT was revealed from 3.2 % in group A to 25.8 % in group B, p = 0.026.

Conclusion. Monitoring compliance with empirical AMT protocols allowed to increase the number of cases of adherence to approved protocols, which positively affected the frequency of adequate appointment of empirical AMT, and also led to increase the number of cases of de-escalation of AMT.

The article contains information about applying bio-engineering potential of the natural origin polymer systems, based on biodegradable polysaccharides, for the wound treatment. The unique biological and physicochemical properties of polysaccharides is a promising direction for atraumatic, controlled restoration of the damaged tissues with extensive acquired defects.

The article presents the successful surgical treatment experience in a patient with deep and extensive purulent-necrotic lesion of the lower limb with a neuroischemic form of the diabetic foot syndrome. The possibilities of modern methods by revascularization, surgical treatment of purulent focus and extensive postoperative complex configuration wounds local treatment are demonstrated.

The article presents the experience of successful complex surgical treatment of a patient who suffered Fournier's gangrene, complicated by the development of severe sepsis and septic shock.

Venous thrombosis and thromboembolic complications are an important public health problem. According to current recommendations for the diagnosis, treatment and prevention of venous thromboembolic complications, patients are stratified by the risk of pulmonary embolism, by the risk of death in pulmonary embolism, respectively, diagnostic and therapeutic tactics are recommended. Adherence to the recommendations allows to reduce mortality from pulmonary embolism, in the opposite case, mortality from pulmonary embolism remains high due to the problems of rapid diagnosis and risk-adjusted therapy. If pulmonary embolism is a frequent complication of venous thrombosis, then venous gangrene is a rather rare complication, which is also characterized by high mortality. A rare case of a combination of two serious complications of deep vein thrombosis is described: thromboembolism of the pulmonary artery and venous gangrene of both lower extremities. Late diagnosis and late treatment led to amputation of both lower extremities, performed in the presence of a floating thrombus in the inferior vena cava and right heart. The causes of late diagnosis and the complexity of the treatment of simultaneously developed two complications are analyzed.