Diabetic foot infection - diagnosis and treatment.

Diabetic foot (DF) is one of the most serious complications of diabetes, leading to high morbidity and mortality in patients with diabetes, significantly affecting their quality of life and placing a huge burden on the healthcare system. Diabetic foot infection (DFI) is a major factor in the non-healing of diabetic ulcerations of the lower limbs, increases the number of hospital admissions, prolongs their duration and is a frequent cause of increased number of amputations. The most serious form of foot infection is osteomyelitis. Management of infection in SDN includes proper diagnosis, including obtaining appropriate specimens for culture, indication of rational antimicrobial therapy or early surgical intervention, and provision of all other necessary wound care and overall patient care to prevent recurrence of DFI.

Epidemiology and Outcome of Nontraumatic Lower Limb Amputations.

Background: In order to create a solid evidence base for the development of improved management methods, this study was performed to describe the epidemiology and outcome of nontraumatic lower limb amputations (LLAs). Methods: This descriptive case series was conducted over a period of 4 years. It included all patients of both sexes and all ages who underwent LLAs for nontraumatic indications. Results: There were a total of 217 patients with 136 (62.67%) men and 81(37.32%) women. The age range was 7 to 71 years, with a mean of 54.25 ± 11.49 years. The most common indication for amputation (41.47%) was diabetic foot gangrene. The most common level of amputation (48.29%) was below knee amputation. Conclusion: Patients with diabetic foot gangrene, malignant tumors, and chronic neuropathic ulcers with osteomyelitis constituted the bulk of the amputees. Diabetes mellitus, obesity, and hypertension were the commonest comorbidities identified among them. Public awareness and education would ensure prompt and early health seeking at the appropriate time and help to prevent the need for major amputations in many instances. The amputees' improved reintegration into society and ability to become contributing members of society would be ensured by the provision of vigorous rehabilitation.

Development of AI classification model for angiosome-wise interpretive substantiation of plantar feet thermal asymmetry in type 2 diabetic subjects using infrared thermograms.

Diabetic Foot Syndrome (DFS) is the prime impetus for most of the lower extremity complications among the diabetic subjects. DFS is characterized by aberrant variations in plantar foot temperature distribution while healthy subjects exhibit a symmetric thermal pattern between the contralateral and ipsilateral plantar feet. Thus, "asymmetry analysis" of foot thermal distribution is contributory in assessment of overall foot health of diabetic subjects. The study, aims to classify symmetric and asymmetric foot regions angiosome-wise, by comparing minimal number of color image features - color moments and Dissimilarity Index. Further, the asymmetric foot regions are assessed for identifying the hotspots within such angiosomes of the patients that characterize the possibility of onset of diabetic foot ulcer. The color feature based machine learning model developed, achieved an accuracy of 98% for a 10-fold cross validation, test accuracy of 96.07% and 0.96 F1-score thereby convincing that the chosen features are amplest and conducive in the asymmetry analysis. The developed model was validated for generalization by testing on a public benchmark dataset, in which the model achieved 92.5% accuracy and 0.91 F1 score.

The Problem of Wound Healing in Diabetes-From Molecular Pathways to the Design of an Animal Model.

Chronic wounds are becoming an increasingly common clinical problem due to an aging population and an increased incidence of diabetes, atherosclerosis, and venous insufficiency, which are the conditions that impair and delay the healing process. Patients with diabetes constitute a group of subjects in whom the healing process is particularly prolonged regardless of its initial etiology. Circulatory dysfunction, both at the microvascular and macrovascular levels, is a leading factor in delaying or precluding wound healing in diabetes. The prolonged period of wound healing increases the risk of complications such as the development of infection, including sepsis and even amputation. Currently, many substances applied topically or systemically are supposed to accelerate the process of wound regeneration and finally wound closure. The role of clinical trials and preclinical studies, including research based on animal models, is to create safe medicinal products and ensure the fastest possible healing. To achieve this goal and minimize the wide-ranging burdens associated with conducting clinical trials, a correct animal model is needed to replicate the wound conditions in patients with diabetes as closely as possible. The aim of the paper is to summarize the most important molecular pathways which are impaired in the hyperglycemic state in the context of designing an animal model of diabetic chronic wounds. The authors focus on research optimization, including economic aspects and model reproducibility, as well as the ethical dimension of minimizing the suffering of research subjects according to the 3 Rs principle (Replacement, Reduction, Refinement).

Possibilities of Multilayer Perceptron in Complexing Risk Factors of Diabetic Foot Syndrome.

The levels of markers of endothelial dysfunction, MMP9, and polymorphisms of genes of vascular tone regulation factors, platelet receptors, vascular wall remodeling and prothrombotic factors, and markers of endothelial dysfunction were studied in patients with complicated and uncomplicated diabetes mellitus. It was found that the neural network analysis of these data makes it possible to predict the development of diabetic foot syndrome with an accuracy of 92.9%. The high accuracy of neural network analysis is due to the multifactorial nature of the diabetic foot syndrome.

Podiatric care from diabetologists point of view.

Scoring for the risk of Diabetic foot syndrome (DFS) should be performed regularly in each patient with diabetes mellitus (DM). Patients at risk for DFS should be followed by diabetologists, those with moderate and severe risk for the development of DFS or those with DFS in remission should be already followed by podiatrists. The aim of our study was to determine the extent of DFS risk screening procedures, dispensary care of patients at risk for DFS and treatment of patients with newly developed DFS in diabetes clinics in the Czech Republic. METHODS: To find out the study data, we prepared in cooperation with the ČDS ČLS JEP Committee a questionnaire survey for outpatient diabetology specialists. RESULTS: The questionnaire was completed by 57% (76/135) of diabetologists. Most of them dispensary approximately 1000- 2000 patients with DM. Their feet are checked by 98.7% of diabetologists (1.6 ± 0.8 times a year on average). Screening for the risk of DFS (13024) is performing in less than 100 patients by 74.3% of diabetologists, in 100-200 patients by 14.9% and in more than 200 patients by 10.8% of diabetologists. 77% of respondents are able to examine neuropathy, the rest send their patients to neurologists, peripheral arterial disease is evaluated by only 47.3% of diabetologists (35.3% of them use some form of instrumental examination), others (48.6%) send patients to angiologists, 4.1% of diabetologists do not examine PAD at all). Based on the assessed findings, more than half of the respondents (50.7%) perform scoring for the risk of DFS, but 1/5 of outpatient diabetologists do not know how the scoring is performed. If colleagues find a patient at a risk for DFS, they usually follow him/her by themselves (64.4%), in 24.6% of cases they send the patient immediately to podiatry or surgery (11%). If a patient with a new DFS comes at diabetology clinic, 72.6% of diabetologists are able to prescribe off-loading, 60.3% antibiotics, 47.9% local therapy. Only 52.1% of diabetologists send a patient with a new DFS to outpatient foot clinic, 39.7% to surgery, the rest of them elsewhere. CONCLUSION: Based on the questionnaire survey results, the screening of DFS is currently severely undersized in outpatient diabetology clinics, it is sufficiently performed only by 11% of diabetologists. Only 16% of diabetologists perform some form of non-invasive diagnostic procedures detecting peripheral arterial disease, neuropathy examinations are more common. If a diabetologist meet a patient with newly developed DFS, he/she is able to prescribe off-loading or antibiotics, but only half of the diabetologists send the patient to outpatient foot clinic, probably due to a lack of them or their overload.

[Algorithm for balloon angioplasty in patients with critical limb ischemia with diabetic foot syndrome]. / Algorytm do angioplastyki balonowej u pacjentów z krytycznym niedokrwieniem z zespolem stopy cukrzycowej.

Currently, there is no reliable and ideal criterion for assessing the level of tissue viability in critical limb ischemia in patients with diabetic foot syndrome, which does not allow the selection of patients for revascularization. AIM: The aim is to investigate the microcirculation of the lower extremities before and after balloon angioplasty and to develop an algorithm for its implementation depending on the characteristics of purulent-necrotic complications. MATERIALS AND METHODS: The study was performed in 67 patients with neuroischemic form of diabetic foot syndrome. 3 groups of research were created: the first group included 18 patients with dry gangrene of one toe, several toes or distal foot; in group II - 35 patients with wet gangrene with signs of purulent arthropathy of the toes, phlegmon of the foot and with chronic wounds on the feet and legs; Group 3 - 14 patients diagnosed with purulent-necrotic complications, which were observed in both the 1st and 2nd groups, where patients refused to perform balloon angioplasty. Such patients underwent conservative treatment of lower extremity ischemia. RESULTS: It was shown that all patients have low levels of TcpO2- less than 30 mm Hg. The change in the value of TcpO2 during treatment turned out to be interesting: Group I indicator before revascularization was - 15.0±1.31 mm Hg, after the restoration of blood flow for 5- 7 days - 35.53±2.92 mm Hg. after 6 months - 36.67±2.35 mm Hg; Group II before revascularization - 10.35±0.74 mm Hg, for 5-7 days - 25.06±1.13 mm Hg, after 6 months - 34.43±1.97 III group at admission to the hospital - 12.14±0.86 mm Hg, for 5-7 days - 17.14±0.9 mm Hg, after 6 months - 13.71±2.2 mm Hg. CONCLUSIONS: After revascularization, there is a reperfusion syndrome, the severity of which depends on the number of revascularized vessels of the lower extremity. Balloon angioplasty is one of the priority methods of surgical treatment of limb ischemia with lesions of the shin-foot segment.

[Collagen-based biological dressings in the treatment of chronic wounds in diabetic foot syndrome]. / Biologicheskie povyazki na osnove kollagena v lechenii khronicheskikh ran pri sindrome diabeticheskoi stopy.

One of the end-organs of diabetes mellitus (DM) is the skin. Cellular and molecular disorders occurring in the skin due to chronic hyperglycemia, neuropathy, and micro- and macroangiopathy lead to poor-heling foot wounds in patients with diabetes. Consequently, treating wounds in diabetic foot syndrome (DFS) is prolonged, costly, and often ineffective. The research on wound healing and treating wounds in DM with stricter adherence to international guidelines and technological breakthroughs in developing biological materials provide new therapeutic opportunities to solve wound care problems. Collagen is one of the body's many proteins, essential throughout the healing phases for skin repair and remodeling. Collagen is one of the body's many proteins, essential throughout the healing phases for skin repair and remodeling. The article addresses the features of biological dressings based on the lyophilized native triple-helix (non-hydrolyzed) collagen formulation. Also, we present clinical cases of their use in different phases of wound healing in DM.

What are the specifics of diabetic foot syndrome and why we need interdisciplinary recommendations for its diagnosis and treatment?

The care of patients with diabetic foot syndrome (DFS) requires interdisciplinary cooperation, and therefore interdisciplinary recommendations focused on the diagnosis and treatment and prevention of DFS are in place. We also need these recommendations because DFS has its own specifics that affect its diagnosis, therapy, but also the prognosis of patients. These include, for example, the different course of infection and PAD in patients with diabetes, the diagnosis of neuropathic Charcot osteoarthropathy, and the frequent association with end stage kidney disease, which worsens the course of SDN and increases its risk. Last but not least, the specifics of DFS include the issue of amputations with a significantly worse prognosis than in people without diabetes. The creation of an interdisciplinary team in foot clinics, providing comprehensive care for patients with DFS according to the recommended procedure, is associated with improved prognosis of patients with DFS, especially the reduction of amputations.

[Negative pressure wound therapy in the treatment of diabetic foot syndrome - a case report]. / Zastosowanie terapii podcisnieniowej w leczeniu zespolu stopy cukrzycowej ­ opis przypadku.

Diabetic foot syndrome is in the variety of diabetes complications. It is one of the most severe and common, is usually observed in the elderly mainly in poorly controlled diabetes. The proper treatment requires involvement of doctors of various specialities and, although numerous newest, supportive therapies and rehabilitation are used, the diabetic foot syndrom may lead to limb amputation and, consequently, serious disability. A CASE REPORT: A patient was hospitalized in the Department of Oncological Surgery UCK in July and August 2020. He was admitted to the Department from the Emergency Department due to the phlegmon of the left foot and toes necrosis in progress of the diabetic foot syndrome. The patient was treated with type II insulin-dependent diabetes for many years. In the last months before admission to the hospital, the controls in the Diabetic and Diabetic Foot Syndrom Outpatient Departments were not exact due to the ongoing pandemic of COVID- 19. Thanks to the use of modern techniques of local wound healing, including negative pressure wound therapy and supportive therapies it was possible to preserve the limb, despite being qualified for amputation on admission to the hospital. We achieved a fairly good cosmetic effect and in the consequence - a chance for an independent life in an acceptable condition. CONCLUSIONS: The involvement of medical personnel, the use of negative pressure therapy and hyperbaric oxygen in the treatment of wounds and supportive therapies allowed for limb preservation and improvement of the patient's quality of life.

Distally Based Pedicled Fibula Flap for Reconstruction of Infected Charcot's Midtarsal Collapse-Diabetic Rocker Bottom Foot.

Introduction and Methods Diabetic rocker bottom foot with secondary infection exacts the expertise of a reconstructive surgeon to salvage the foot. The author selected 28 diabetic patients with secondarily infected Charcot's degenerated rocker bottom feet and reconstructed their feet using distally based pedicled fibula flap. Reconstruction was done in a staged manner. Stage 1 surgery involved external fixation following debridement. In stage 2, struts were activated for distraction and arthroereisis. In stage 3, the distally based pedicled fibula was used for reconstruction and beaming of the arches. Results In this retrospective study, the author analyzed the outcome of all 28 patients using the Musculoskeletal Tumor Society Rating (MSTSR) score. The average MSTSR score was 27.536 in an average follow-up of 30.5 months. The limb salvage rate with the author's procedure was 96.4% ( p = 0.045). Conclusion Author's protocol for the staged reconstruction and salvage of the infected diabetic rocker bottom foot, using the pedicled fibula flap, will be a new addendum in the reconstructive armamentarium of the orthoplastic approach.

COMPARATIVE CHARACTERISTICS OF TREATMENT RESULTS USING THE OFFLOADING MEANS IN PATIENTS WITH PURULENT-NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME.

OBJECTIVE: The aim: To conduct a comparative analysis of clinical data, laboratory results, and pain intensity in patients using developed by us device for offloading the foot and plaster splint during inpatient treatment of purulent-necrotic complications of diabetic foot syndrome. PATIENTS AND METHODS: Materials and methods: We examined 76 patients with purulent-necrotic complications of diabetic foot syndrome, who used a plaster splint and a device for offloading the foot. We evaluated the clinical indicators of the healing process, laboratory data and pain intensity. RESULTS: Results: Comparing the results of using the device for offloading the foot and the plaster splint showed that the developed by us device had a positive effect on the dynamics of the healing process: the edema disappeared on average 1.5 days earlier; the redness vanished on average 2.5 days earlier. We observed granulation and epithelialization significantly earlier (p <0.05) than in the group where the plaster splint was used. The number of recorded surgical interventions was statistically significant and less (p <0.05) in the group where our device was used. Low pain rates were in patients using a device for offloading the foot due to minimal contact of the wound surface with the floor. CONCLUSION: Conclusions: According to the results of comparative using the device for offloading the foot and plaster splint, we found out that using the device for offloading the foot allows creating statistically significant better conditions to accelerate wound healing in patients and reduce the duration of inpatient treatment.

A Methodological Assessment of Diabetic Foot Syndrome Clinical Practice Guidelines.

OBJECTIVE: Diabetic foot syndrome (DFS) contributes to significant morbidity in diabetic patients. Diagnostic and therapeutic approaches to DFS may be summarised in clinical practice guidelines (CPGs) to aid clinical practice but may only benefit patients if the CPG is of high quality. This study determines the methodological quality of DFS CPGs using a validated assessment tool to identify CPGs adequate for use in clinical practice. METHODS: Medline, EMBASE, and CPG databases were searched to 31 May 2019. Reference lists were also searched. Full text English evidence based DFS CPGs were included. CPGs based on expert consensus, guideline summaries, or those only available if purchased were excluded. Four reviewers independently assessed methodological quality using the Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered to be of adequate quality to recommend use. RESULTS: Sixteen CPGs were identified. Good inter-reviewer reliability (ICC 0.985, 95% CI 0.980-0.989) was achieved. Poor scores were noted in domains 2 (stakeholder involvement), 5 (applicability), and 6 (editorial independence). Significant methodological heterogeneity was observed in all domains with the most noted in domain 6 (mean scaled score 43.2 ± 32.1%). Four CPGs achieved overall assessment scores of ≥80%. CONCLUSION: Four CPGs were considered to be adequate for clinical practice based on methodological quality. However, elements of methodological quality were still lacking, and all CPGs had areas for improvement, potentially through increased multidisciplinary team involvement and trial application of recommendations. Methodological rigour may be improved using structured approaches with validated CPG creation tools in the future. Future work should also assess recommendation accuracy using available validated assessment tools.

Editor's Choice - International Variations and Sex Disparities in the Treatment of Peripheral Arterial Occlusive Disease: A Report from VASCUNET and the International Consortium of Vascular Registries.

OBJECTIVE: The aim of this study was to determine sex specific differences in the invasive treatment of symptomatic peripheral arterial occlusive disease (PAOD) between member states participating in the VASCUNET and International Consortium of Vascular Registries. METHODS: Data on open surgical revascularisation and peripheral vascular intervention (PVI) of symptomatic PAOD from 2010 to 2017 were collected from population based administrative and registry data from 11 countries. Differences in age, sex, indication, and invasive treatment modality were analysed. RESULTS: Data from 11 countries covering 671 million inhabitants and 1 164 497 hospitalisations (40% women, mean age 72 years, 49% with intermittent claudication, 54% treated with PVI) in Europe (including Russia), North America, Australia, and New Zealand were included. Patient selection and treatment modality varied widely for the proportion of female patients (23% in Portugal and 46% in Sweden), the proportion of patients with claudication (6% in Italy and 69% in Russia), patients' mean age (70 years in the USA and 76 years in Italy), the proportion of octogenarians (8% in Russia and 33% in Sweden), and the proportion of PVI (24% in Russia and 88% in Italy). Numerous differences between females and males were observed in regard to patient age (72 vs. 70 years), the proportion of octogenarians (28% vs. 15%), proportion of patients with claudication (45% vs. 51%), proportion of PVI (57% vs. 51%), and length of hospital stay (7 days vs. 6 days). CONCLUSION: Remarkable differences regarding the proportion of peripheral vascular interventions, patients with claudication, and octogenarians were seen across countries and sexes. Future studies should address the underlying reasons for this, including the impact of national societal guidelines, reimbursement, and differences in health maintenance.

[Wound treatment in diabetes patients and diabetic foot ulcers]. / Wundbehandlung bei Diabetes und diabetischem Fußulkus.

Diabetes mellitus (DM) is a paramount and rising medical challenge in both industrial and emerging nations. For Germany, 6.9 million out of 64.9 million insured persons in 2010 were reported to suffer from DM and approximately 5.8 million suffered from type 2 DM. The prevalence of diabetic foot ulcer (DFU) or diabetic foot syndrome (DFS) is 2-10% and the incidence is 2-6%. In addition, patients with DM present associated skin disorders with chronic wound healing, e.g., pyoderma gangrenosum or lecrobiosis lipoidica. Knowledge of the pathogenesis and skills for treatment of chronic wounds in diabetic patients are important for dermatologists. Patients with diabetes and wound healing disorders and accompanied unspecific skin disorders like eczema, cellulitis or contact dermatitis are often primarily or secondarily treated by dermatologists. In this article, practical hints for the treatment of DFS and other chronic wound in patients with DM are presented.

[Treatment of torpid trophic ulcers in patients of the older age group.]

Chronic ulcers or non-healing ulcers are more common in the elderly (20 out of 1 000 people), whose age is closer to 80 years. The application of the principles of regenerative medicine, actively developing, in the treatment of such diseases, is based on the use of both autologous blood derivatives and autologous mononuclear cells. Objective: to evaluate the effectiveness of the use of plasma enriched with platelets in the treatment of torpid ulcers of the lower extremities in patients of the older age group. A prospective, randomized clinical trial was conducted in 80 patients. According to preliminary calculations, it has been shown that the combination of traditional treatment with the introduction of plasma enriched with platelets leads to accelerated healing of ulcers.

[Estimating prevalent microvascular complications of diabetes mellitus in Germany. Analysis of statutory health insurance data in 2012 and 2013]. / Einschätzungen zur Prävalenz mikrovaskulärer Folgeerkrankungen bei Diabetes mellitus in Deutschland. Analyse von Versichertendaten aller gesetzlichen Krankenkassen für die Jahre 2012 und 2013.

BACKGROUND: Data sources for the systematic and ongoing analysis of prevalence of microvascular complications of diabetes mellitus are limited in Germany. For the first time, we estimated the complications prevalence based on claims data of all statutory health insurance (SHI) providers according to the Data Transparency Act. METHODS: Health claims data of the reporting years 2012 and 2013 were analyzed. The reference population was identified as insured persons with a diabetes diagnosis according to the international classification of disease. Diabetes was defined as documentation of at least two confirmed diabetes diagnoses in an outpatient setting or one diagnosis in an inpatient setting (ICD codes E10-E14). Complications were defined based on the following ICD codes: nephropathy (N08.3), retinopathy (H36.0), polyneuropathy (G63.2), diabetic foot syndrome (DFS; E10-14.74, E10-14.75), chronic kidney disease (N18.-), and treatment with dialysis (Z49.1, Z49.2, Z99.2). Results were compared to prevalence estimates based on routine data and registries in Germany and abroad. RESULTS: In 2013, diabetes was documented for 6.6 million persons with SHI (2012: 6.5 million). In 2013, chronic kidney disease (15.0%) was the most frequent complication, followed by diabetic polyneuropathy (13.5%), nephropathy (7.6%), retinopathy (7.0%), DFS (6.1%), and treatment with dialysis (0.56%). While results for diabetic retinopathy, nephropathy, and polyneuropathy are lower than prevalence estimates from other type 2 diabetes studies, they are comparable for chronic kidney disease, treatment with dialysis, and DFS. CONCLUSION: Continuous analysis of health claims data is highly valuable for the diabetes surveillance. However, detailed analyses are required for verification and harmonization of case definitions and documentation practice.

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome.

Background and objectives: Diabetic foot ulcer (DFU) is one of the serious complications of diabetes, being related to frequent and long-term hospitalisation, reduced quality of life of the patient, amputations, a high rate of morbidity and mortality. The bacterial aetiology is complex, sometimes involving more than one pathogen, playing a major role in the infection prognosis and development of microbial resistance. This study evaluated the current state of the aetiology, clinical and pathological characteristics of DFU in a single diabetes centre in order to provide some specific measures to prevent it. Materials and Methods: This retrospective study was conducted on patients with diabetes mellitus (252 individuals diagnosed with DFU) between January 2018-December 2019. All participants were assessed based on their clinical characteristics, including complications of diabetes and pathological and microbiological evaluations. Results: The present research revealed that diabetic foot ulcer prevalence was higher in males than in females and higher in type 2 diabetic patients than in type 1 diabetic patients. The patients with diabetic foot ulcer were older, had a higher body mass index (BMI), longer diabetic duration and had more diabetic complications, such as retinopathy, diabetic polyneuropathy and diabetic kidney disease, than patients without diabetic foot ulceration. Conclusions: Taking into account all factors involved, including the aetiology and the antibiotic susceptibility pattern of these isolates, planning the suitable treatment options of patients is possible.

Current possibilities of wound dressing with regard to pathophysiology of healing.

Optimization of chronic wound treatment has been constantly a subject of research. Understanding the physiological healing of wounds, permanent development of new dressing materials and correct observance of antiseptic guidelines have led to new approaches in the care of chronic wounds. The primary objective in treatment and care of chronic wounds is rapid wound closure with a functional and aesthetically acceptable scar. Though primary healing wounds is simple, many problems occur in chronic wounds, especially in the elderly and in patients with associated comorbidities. The wound should be maintained in conditions ensuring physiological healing. The condition of each wound must be properly evaluated; the wound must be carefully cleaned and then treated individually according to the current stage of healing. Many of the formerly used therapeutic procedures are outdated today. At present we have numerous modern materials including bioactive dressings which should be used in treatment of chronic wounds. New findings in molecular and cellular biology have improved our knowledge of the physiological healing of wounds and the approach to wound treatment.

[Endovascular revascularisation in patients with necrotic wounds and extended infrainguinal arterial disease]. / Endovaskulyarnaya revaskulyarizatsiya u patsientov s gnoino-nekroticheskimi ranami nizhnikh konechnostei s infraingvinal'nym protyazhennym porazheniem arterial'nogo rusla.

OBJECTIVE: To report own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. MATERIAL AND METHODS: We have analyzed literature data and own experience of endovascular interventions in patients with extended occlusive lesion (TASC II D) of the femoral-popliteal and tibial arteries and concomitant purulent-necrotic wounds. RESULTS: Endovascular strategy is preferable in a certain subgroup of patients with extended infrainguinal lesions. CONCLUSION: Considering own data, we assumed the need for routine correction of outflow pathways (simultaneous angioplasty of at least 2 tibial arteries). Primary results are encouraging, but further research is required.