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An analysis of results of complex treatment of 160 patients with purulent complications of the diabetic foot has allowed optimization of the decision on surgical strategy using the proposed formula depending on the severity of the general state of the patients. The decision on the surgical strategy of treatment taking into account the indices of the severity of the disease led to 2.5 times less number of "great" amputations and 29% shorter duration of the patients' staying at the hospital.

Activity of lipid peroxidation processes in blood was studied in 60 patients with atherosclerotic gangrene of the lower extremity subjected to amputation of the extremity in a prospective controlled investigation. Activation of the lipid peroxidation processes with a lower number and less activity of the antioxidant system enzymes was demonstrated in patients with severe critical ischemia of lower extremities. The operation trauma was followed by further stress of the system of free radical oxidation of lipids. The increased concentration of lipid peroxidation products with a decreased or low level of activity of the antioxidant system enzymes allows prognosis of the development of purulent complications at the early postoperative period.

At admission of patients with gangrenes of both lower extremities the surgical strategy was not determined. The author has also failed to find corresponding recommendations in the available literature. On the basis of his clinical experiences with 12 patients who underwent big amputation of lower extremities for bilateral gangrene, the author proposes the surgical methods. The optimal variant is considered to be a by turns amputation with the interamputation period being determined by a relative stabilization of the life-support systems.

Total retrospective clinical-social investigation of 2431 patients with pyo-necrotic complications of the diabetic foot syndrome (DFS) has revealed a considerably increased incidence of pyo-necrotic complications of DFS, mainly at the expense of patients with type II diabetes mellitus. Most of these patients (87.8%) are elderly and senile patients with a middle or severe degree of diabetes (98.2%) and signs of subcompensation or decompensation (87.2%). In 98.0% of the patients there were coexisting diseases. 87.9% of the patients were urgently admitted to hospital with acute pyo-inflammatory processes. A comparison of the results has shown that treatment and interdisciplinary observation in specialized institutions allowed to reduce lethality and number of high amputations more than two times.

A variety of clinical variants, the absence of a common opinion on the terms and volume of surgery hamper the selection of the right strategy of treatment. Search for simple and open to general use methods of investigation of the state of hemocirculation in the extremity still remain actual which could help determine the surgical strategy at the early terms of treatment. Clinico-instrumental investigations in 60 patients with necrotic diseases of feet allowed detection of group differences in the character and degree of hemodynamic disorders and confirmed the necessity to differentiate gangrenous injury of the foot determining choice of the operative policy and probable prognosis of the outcome of the disease.

A method of active outstripping incisions with special reference to the localization of the primary anaerobic focus and possible pathways of the spreading of purulent exudate is proposed on the basis of experiences with surgical treatment of 14 patients with acute anaerobic paraproctitis and investigations of topographical-anatomical localization of cellular spaces in the pararectal area.

Investigations of the system of general and regional hemostasis in patients with diabetes mellitus and the IVth degree of ischemia of lower extremities have established the development of chronic hypercoagulation-thrombotic forms of disseminated intravascular blood coagulability. Prophylactics of thrombotic complications allows to avoid high amputations in 80% of the patients, to make only necrectomies, small amputations and dermoplasty.

The method of treatment after Ilizarov was used in 28 patients with occlusion of lower extremity arteries, mainly of distal localization, with the III and IV degrees of ischemia. Osteotomy of mainly the tibial bone and distraction of the free osseous split was performed during 31-36 days. Two patients had fractures of the bone during operative interventions, after operation four patients had purulent complications or necrosis of the skin around the wire. The immediate positive result was noted in 20 patients. Their fate was followed-up in remote periods from 2 to 19 months, good results were observed in 18 patients. The use of the Ilizarov method was most justified in patients with the III and IV degrees of ischemia when other methods of treatment failed to give any effect and surgical reconstruction of the vessels is impossible. When treating patients with the IV degree, it is necessary to take into consideration the late appearance of revascularization and possibility of temporary deterioration. The use of the Ilizarov method foresees provision of the joint work of an angiosurgeon and a traumatologist-orthopedist.

The authors' experience with the treatment of 134 patients enabled them to formulate indications for sympathectomy, reconstructive operations and primary amputations.

Seven cases of pulmonary gangrene are reported. The conservative therapy would somewhat improve the general patient's condition, but the destructive process in the lung proceeded. One patient was subjected to thoracotomy, in 6 subjects due to the extensive lesion pneumonectomy was performed. Postoperatively, pleural empyema developed in all patients, the former was eliminated by punctures and lavage of the pleural cavity during 2 months. One patient died after pneumonectomy, the remaining 5 patients radically operated upon were discharged with a completely liquidated suppurative process. It is the author's opinion that pneumonectomy seems to be a perspective and radical method of treatment for gangrene. Pneumotomy should be accomplished only in extremely grave cases.

On the basis of the experience with the treatment of 69 patients with lung gangrene the authors recommend to use a combination of active aspiration from the pleural cavity, occlusion of the segment bronchus and pneumoperitoneum for the efficient expansion of the lung after its resection in the early postoperative period.