Object - Patient with diabetes mellitus with purulent and necrotic infringements of foot tissues in elderly and senile age and similar patients in young or middle age. Purpose - the reduction of lethality and disablement levels in patient of elderly and senile age with purulent and necrotic infringements of lower extremities tissues, suffering from diabetes mellitus, on the basis of ascertained peculiarities of clinical course, improved diagnostics and developed rational treatment tactic. Methods - clinical, laboratorial, electrophysiological, morphological radiographic, statistics. Novelty - In this work for the first time the evaluation of developed in the clinic method's effectiveness of morphological diagnostics of diabetic microangiopathy stage in patient with diabetes mellitus in the treatment of trophic, purulent and necrotic foot infringements depending on the age is given. The pathogenesis of inertly granulating traumatic process is studied and grounded and the ways of correction of "stark trauma syndrome" are planned. For the first time, on the basis of performed clinical-radiographic and morphological investigations in patients with ulcerous necrotic infringements the possibility of organs-retentive operations is grounded for the line of elderly patients with occlusive infringements of main arteries of the extremities. The new approaches to the glycemia level correction in pre- and postoperative periods are grounded in elderly and senile patients with purulent and necrotic foot infringements without insulin use. Results - Received clinical results allow creating the prerequisites for the performance of organs-retentive operations. Received clinical results allow performing the correction of glycemia level with tablet medicines without insulin use if the level of glycemia is under 11 mmol/l and if the moist necrosis and signs of purulent intoxication are absent. In treatment inertly granulating traumatic process, the most effective approaches are early autoplastic closing of the traumatic defect, intra-arterial therapy with the use of medicines of vasoprostan group, antibiotics, low molecular dexstranes and the activation of local fibrinolysis with the help of our developed method of hirudotherapy. The principles of surgical treatment of trophic, purulent and necrotic infringements of lower extremities tissues in elderly and senile patients, suffering from diabetes mellitus, which were used by us, allowed to substantially reduce the indexes of lethality from 14,5% to 4,3% and disablement from 32,7% to 12,7%. Application - were applied to the medical practice of the vascular center of surgical departments in Donetsk and Donetsk region, including the municipal center of "surgery of diabetic foot", and surgical departments of the central clinical hospital "Ukrzaliznutsya" in Kharkiv, regional clinical hospital in Kherson, municipal hospital №9 in Lugansk, vascular department of regional hospital in Jitomir. Field - medicine (surgery).
