[Optimization of treatment of septic wounds in patients with diabetic foot ulcers].

An analysis of complex examination and treatment was made in 116 patients with necrotic suppurative complications. Patients were divided into two statistically homogeneous groups. An ointment "Levomekol" was used in control group and immobilized forms of chlorhexidine bigluconate was applied in the main group. The dynamics of traumatic process course was learned by planimetric, bacteriological and cytological methods. The percentage of area reduction of wounds in the main group was higher, than in control group: on the third day--on 1.59%, on the fifth day--on 3.16%, on the seventh day--on 5.86%, on the tenth day--on 6.83%, on the fourteenth day--on 7.80%, on the twenty-first day--on 7.62%. A microbial contamination of wounds (generated colony units in 1 g of tissue) was less, than in control group on the third day of treatment--on 1.6 x 10(6), on the fifth day--on 26.2 x 10(5), on the seventh day--on 77.8 x 10, on the tenth day--on 2.2 x 10(4) and on the fifteenth day--on 0.3 x 10(3) (p < 0.05). The number of granulocytes was less in main group: on the third day--on 11.8%, on the fifth day--on 14.2%, on the seventh day--on 8.8%, on the tenth day--on 5.2%. The quantity of fibroblasts (a number of reparative cells) was more in wounds of the main group in the same terms: 2.9%, 5.8%, 3,.6%, 4.4%, respectively. Thus, the treatment of suppurative wounds by the immobilized form of chlorhexidine bigluconate was proved pathogenetically reasonable and effective.

[The mechanisms of the development of decompensated forms of varicose veins]. / Mekhanizmy razvitiia dekompensirovannykh form varikoznoi bolezni.

The functional (rheovasography, photoplethysmography), ultrasonic (dopplerography) and roentgenological (distal ascending and retrograde popliteal and talocrural phlebography) methods of investigation were used for studying the state of the musculo-venous pump of the crus in 50 patients with the varicose disease in the stage of trophic disorders. It was established that the formation of pathological capacities in the crural muscular veins and leakage of blood from the posterior tibial into deep plantar veins was responsible for the development of the decompensated course of this disease.

[The pathogenetic validation of the volume and the technology for the surgical correction of disorders in the musculo-venous pump of the lower extremities in patients with decompensated forms of varicose veins]. / Patogeneticheskoe obosnovanie ob''ema i tekhnologiia khirurgicheskoi korrektsii narushenii myshechno-venoznoi pompy nizhnikh konechnostei u bol'nykh s dekompensirovannymi formami varikoznoi bolezni.

The state of the venous, capillary blood circulation and lymph flow was studied in 70 patients with varicose disease at the stage of trophic disorders with the help of photoplethysmography, rheovasography, dopplerography, distal ascending and retrograde femoral, popliteal, talocrural phlebography, lymphography. It was established that a sharp disturbance of the musculo-venous pump function caused decompensation of not only the venous blood circulation but also the lymph flow, while the removal of the subcutaneous veins of the crus is not possible without deterioration of the lymphatic drainage. The authors propose not to ablate the main trunks of the subcutaneous veins on the crus but to perform occlusion of the autovein ablated from the femur. A technology of resection of the pathologically altered vein of the soleus and gastrocnemius muscles and retrograde occlusion of the posterior tibial veins is developed for improving the work of the musculo-venous pump of the leg. Good results of treatment were obtained in 84.3% of the patients.

[The pathogenesis and surgical treatment of trophic ulcers of the lower extremities against a background of varicose veins]. / Patogenez i khirurgicheskoe lechenie pri troficheskikh iazvakh nizhnikh konechnostei na pochve varikoznoi bolezni.

The state of the musculo-venous pump of lower extremities was studied in 72 patients with trophic ulcers caused by varicose disease. The methods used were: phlebotonometry, phleboplethysmography, US dopplerography, distal ascending and retrograde-femoral, popliteal and talocrural phlebography. It was established that ectasia and/or valve incompetence of deep and muscle veins of the lower extremities with the formation of blood refluxes along the profound, communicating and superficial veins underlie the disturbances of venous hemodynamics. The authors propose a scheme of pathogenesis of the varicose disease trophic ulcers and recommend to perform pathogenetically justified operations.