Objective – to study the dynamics of reparative processes in the purulonecrotic wound in cases of diabetic foot syndrome. The subjects treated in this study included three groups of patients: Group 1 – after surgical treatment of wounds and topical treatment with ointments on polyethylene glycol basis; Group 2 – after surgical treatment of wounds with hydrosurgical system VersaJet® and intravenous systemic antibiotics therapy, chosen according to the results antibiogram; Group 3 – after surgical treatment of wounds with hydrosurgical system VersaJet® and combination systemic antibiotic therapy (a drug selected as a result of antibiogram plus clarithromycin). There is shown the ultrastructure of a microbial biofilm, the effect of antimicrobial agents on its destruction and the structural and functional state of microbial populations and injury cells. The high efficiency of the hydrosurgery system VersaJet® and combined systemic antibiotic therapy with clarithromycin in the treatment regimen, and dressings with ointments on PEG basis for the treatment of purulonecrotic wounds in patients with neuropathic form of diabetic foot syndrome. Already on the 5th day of the complex wound treatment the morphological study of the biopsy materials of the wounds showed no presence of biofilms on the surface of the wound, and in its deepest layers. Free (plankton-like) cells of microorganisms were also none. Effective purification of wounds from microbial and cellular detritus was indicated that led to the intensification of the functional and proliferative activity of the cells of the granulation tissue. Such dynamics of wound process in almost all Group 3 patients allowed to conduct the final stage of treatment (plastic reconstruction of the foot) in a shorter time. Introduced for the Group 3 of patients the algorithm of complex treatment prevents the formation of new microbial biofilms, increases the activity of systemic antimicrobials even in the identification of multiple-antibiotic resistant strains.

Objective – to study the dynamics of changes in the structure of surgical infectious matter and their sensitivity to antibiotics in patients with diabetes mellitus (DM), depending on the strategy of the surgical treatment. Materials and methods.The subject of this study were clinical samples (biopsy material of the wounds, tissue-prints from the wounds surface, wound fluid, blood, the contents of the drainage tubes, etc.) of 268 patients treated at the department of wounds and wound infections of the A.V. Vishnevsky Surgery Institute in 2012–2015. with various nosologic forms of acute and persistent purulent surgical infections (diabetic foot syndrome, paraendoprosthetic infection after surgery on the arteries of the lower extremities, chronic postoperative osteomyelitis of the sternum and the ribs, chronic posttraumatic osteomyelitis of long bones, chronic ulcers of venous etiology, necrotic wounds of various etiologies).  Objective – to study the dynamics of changes in the structure of surgical infectious matter and their sensitivity to antibiotics in patients with diabetes mellitus (DM), depending on the strategy of the surgical treatment. Materials and methods. The subject of this study were clinical samples (biopsy material of the wounds, tissue-prints from the wounds surface, wound fluid, blood, the contents of the drainage tubes, etc.) of 268 patients treated at the department of wounds and wound infections of the A.V. Vishnevsky Surgery Institute in 2012–2015. with various nosologic forms of acute and persistent purulent surgical infections (diabetic foot syndrome, paraendoprosthetic infection after surgery on the arteries of the lower extremities, chronic postoperative osteomyelitis of the sternum and the ribs, chronic posttraumatic osteomyelitis of long bones, chronic ulcers of venous etiology, necrotic wounds of various etiologies).

Objective – to study the morphology of wound process in diabetic patients. Materials and methods. The subjects treated in this study were 180 patients: 122 females (67.8 %) and 58 males (32.2 %). Traditional methods for evaluating the morphology of wound healing have been used: imprint smear of the edge of the wound according to the method of M.P. Pokrovskaya and M.S.Makarov (1942), staining of paraffin sections according to the histochemical methods proposed by D.D. Zerbino and L.L. Lukasevich (1984), study of epidermal thickness and its keratinization degree, measuring of the epidermal zone and dermoepidermal junction. All measurements in histological sections were carried out using the eyepiece-micrometer, the results presented in micrometers. Results. It is found that in patients with diabetes mellitus with increasing duration of the disease occurs thinning of epidermis and the signs of keratinization of the epidermis. In the zone of dermoepidermal junction and dermis in patients with diabetes mellitus there is emergence of adipose tissue. This incidence of adipose tissue correlates with the duration of the disease. The amount of regeneration-degeneration index correlates with the nature of the wound process. Conclusions. In the skin of patients with diabetes mellitus there appear symptoms of parenchymal proteinosis and adipose degeneration, which reflects metabolic imbalance in tissue. The wound process in patients suffering from diabetes mellitus is characterized by prolonged inflammatory phase and delayed regenerative processes.

Objective – to improve the results of the topical medical treatment of wounds in patients with various forms of diabetic foot syndrome (DFS). Materials and methods. A comparative in vitro study of the antimicrobial and osmotic activity of Baneotsin® and ointments on the basis of polyethylene glycol was done. The subject of the clinical study were 18 patients with DFS. Out of these patients 8 (44.4 %) had the neuro-ischemic form and 10 (55.6 %) had the neuropathic form. According to depth and prevalence of purulonecrotic process, in 3 (16.7 %) cases there was indicated Stage II of the process according to Wagner, in 9 (50.0 %) cases – Stage III and in 6 (33.3 %) patients – Stage IV. All patients had type 2 diabetes of severe treatment, on insulin. Average age of the patients was 61.3 ± 1.4 years. The average rate of glycated hemoglobin of patients on ad- mission to hospital was 8.4 ± 1.3 %. After radical surgical treatment of purulent foci with careful removal of all necrotic tissue all patients had surgical wounds treated with 0.2 % solution of Lavasept®. 3 (16.7 %) patients with the ulcer surface without obvious signs of perifocal inflammation had bandage with Baneotsin® powder after treatment, and after 4–5 days after detecting signs of wound process during the transition to phase II the treatment was continued under the bandage with ointment Baneotsin®. In 10 (55.6 %) cases (in the results of microbiological tests were found aerobic and obligate anaerobes) the treatment of postoperative wound was done under the bandages with 5 % Dioxydine ointment for 2–3 days. 5 (27.8 %) patients (without clinical and bacteriological data of obligate anaerobes) were treated with ointment of Levomekol immediately after the operation. After 7–10 days, the patients were discharged to the outpatient treatment phase with recommendations to continue treatment with bandages with Baneotsin® powder (for 4–5 days) and then with ointment Baneotsin®. Systemic antibiotic therapy at the hospital stage of treatment lasting more than 7 days, was used only in 4 (22.2 %) cases. Results. In patients with trophic anabrosis (3 (16.7 %) persons) it was managed to heal the defects by secondary intention in the period of up to 1 month after surgical treatment. The other wounds were prepared to run the final stage of treatment – the plastic reconstruction of the foot in the period from 10–14 days to 1 month. High ablations and fatal cases in the researched group of patients were not recorded. Conclusion. Application of the algorithm of topical drug treatment of wounds with Baneotsin® powder and ointment, polyethylene glycol based ointments having different osmotic activity, depending on the severity and extent of purulent process in soft tissues, lets to avoid the prescription of long-term systemic antibiotic therapy and to accelerate the transition of purulonecrotic wounds in the phase II of wound process.

The article presents clinical examples of surgical treatment of diabetic osteoarthropathy. In both clinical cases, the talipes and plantar ulcerous defects became a significant factor of the threatening high ablation, which was avoided. Restoration of the support function of the foot and absence of recurrent plantar ulcerous defects in the long term is the result of a multidisciplinary team approach to the treatment of these patients. An ambulatory patient is assigned a package of therapeutic measures to prepare for the surgery. After the intervention the patient is compulsory for outpatient treatment in diabetic foot department for further monitoring and rehabilitation. Reconstructive surgery on the foot in patients with diabetic osteoarthropathy under the joint treatment of the patient by the team of specialists (endocrinologist, surgeon, orthopedist) leads to the restoration of the support function of the foot, which enables a full adaptation to the patient's daily life.

The article presents a clinical case of successful surgical treatment of phlegmon in the case of diabetic neuroosteoarthropathy (Charcot foot). This observation illustrates the clinical features, diagnostic algorithm and potential of modern complex treatment of the most  rare form of diabetic foot syndrome which is diabetic neuroosteoarthropathy.

The guideline presents modern classification, diagnostic algorithms and protocols of complex treatment of various forms of diabetic foot syndrome. The recommendations are intended for use by a wide range of professionals involved in the treatment of patients with this pathology.