[Assessment of changes in the lesions sizes and the incidence of complete epithelialization during the treatment of diabetic foot syndrome over a period of 4 weeks (multicenter study)]. / Otsenka dinamiki ploshchadi rany i chastoty sluchaev polnoi epitelizatsii pri lechenii sindroma diabeticheskoi stopy (rezul'taty mnogotsentrovogo issledovaniya).

AIM: To assess the effectiveness of the collagen biomaterial in treatment process in patients with DFS. MATERIAL AND METHODS: 71 patients 30-80 y.o. with diabetic foot syndrome of varying severity were included in prospective multicenter study. Patients were randomized into two homogeneous groups: control group (n=35) - standard therapy, other 36 patients (main group) were additionally treated with medical device (MD) Collost in accordance with the instructions for use. RESULTS: Biomaterial Collost using in complex treatment of diabetic foot syndrome resulted in more rapid and effective healing of the ulcer. The treatment success increased from 43% to 72%. Complete epithelialization was achieved by 2.6 times more rapidly in conjunction with reduction the incidence of unsuccessful treatment results by 4.1 times.

[Lower limb critical ischaemia in patients of a pyoseptic surgery unit].

The authors retrospectively analysed therapeutic results of treatment in a total of 749 patients of the Pyoseptic Surgery Unit with signs of lower limb critical ischaemia. Of these, 101 (13.5%) patients were found to have a pronounced septic process (successfully arrested in 88 patients). A further 86 (11.5%) patients were diagnosed with extended trophic alterations making revascularization unpromising. The incidence rate of "major" amputations in this group amounted to 34.2%, with a lethality rate of 5.9%. Severe somatic pathology was revealed in 106 (14.2%) patients, with the incidence of "major" amputation in this group equalling 27.4% and lethality rate - 10.4%. The neuropathic form of diabetic foot syndrome with no evidence of ischaemia was noted observed in 174 (23.2%) patients, "major" amputations in this group were performed in 3 (1.7%) patients, with a lethality rate of 0.6%. Impossibility of revascularization had previously been ascertained in 98 (13.1%) patients; "major" amputations in this group were performed in 38 (38.8%) patients, with a lethality rate of 6.1%. Sixty-nine (9.2%) patients were admitted for further treatment after previously performed reconstructive operations, including unsuccessful ones; the frequency of major amputations and lethality rate in this group amounted to 13.0 and 2.9%, respectively. Of the total number of the analyzed patients, 207 (27.1%) required considering the problem concerning possibility of revascularization. Surgical revascularization was performed later on in 34 (16.7%) patients in this group, and the incidence of "major" amputations amounted to 5.9% remaining at the same level in the remote period of follow up. In patients who were not subjected to revascularization, the incidence of "major" amputations during 3 months amounted to 9.5% reaching 27.2% by 42 months of follow up. The survival rate after 42 months in these groups amounted to 72.7 and 68.0 %, respectively.

[Bioplastic materials based on native type I collagen in the treatment of diabetic foot syndrome].

Currently, there is an increase in the number of patients with infections of the skin and soft tissue. There is a question of closing tissue defects after the elimination period of acute inflammation. Application auto skin grafting free split-skin graft does not always lead to a positive outcome of primary closure of the defect and to the appearance of one more wound skin. The technique that avoids these drawbacks is proposed.

[Multidisciplinary approach to treatment of patients with lower limb critical ischaemia].

Analysed herein are the results of the joint work of the Pyoseptic Surgery Department of the Centre "Diabetic Foot" with the Vascular Surgery Department based in various clinics over 2 periods - 2010 and 2011. During the first period, a total of 126 patients with critical ischaemia were treated without using revascularizing methods, during the second period, a total of 205 patients with critical ischaemia were examined by vascular surgeons deciding upon the problem concerning possibility of revascularization. In 148 cases (72.2%) revascularization was regarded impossible due to pronounced trophic disorders and/or severity of the general somatic status. Fifty-seven patients were subjected to angiography. Of these, five patients were found to have contraindications to vascular reconstruction, with the remaining 52 patients being subjected thereto (65 operations, of which 22 roentgen-endovascular ones). One (1.9%) patient died. Clinical improvement was achieved in 47 (90.3%) cases, and with no dynamics in four (7.7%) subjects. Using a multidisciplinary approach resulted in a decrease in the incidence rate of high amputations in patients with lower limb chronic ischaemia at the department of Pyoseptic Surgery from 51.6% in 2010 to 35.4% in 2011 (p=0.0000). Of these, the number of the above-the-knee amputations decreased from 41.3% to 15.1%, respectively (p=0.0000). The proportion of crural amputations increased from 20.0% to 46.6% (p=0.04).