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Objective: To clarify the role of clinical anatomy of foot and ankle perforator veins (PV) in surgical treatment of varicose vein disease., Material and Methods: Anatomy of foot and ankle PV was assessed in 50 amputated lower extremities by anatomical dissection., Results: There were 4-6 PVs at the medial surface of the foot. These veins connected medial marginal vein and vv. plantaris medialis (VPM). There were 2-3 PVs at the lateral surface of the foot. These veins connected lateral marginal vein and vv. plantaris lateralis (VPL). All PVs on the lateral surface of the foot constitute the neurovascular bundles. PVs flowing into vv. dorsalis pedis are localized on the medial surface of the medial marginal vein at the level of the ankle base. In most cases, we found an arterial branch nearby at the subfascial level. In anterior part of the plantar surface of the foot, we distinguished 4-5 small PVs (~1 mm) flowing into vv. digitales plantares through the commissural orifices of the aponeurosis. There were 6-9 vessels (~1 mm) along the fascial aponeurotic septa. These vessels connected superficial plantar venous network and plantar veins. Small arterial branch was found almost in all cases near these veins. Noteworthy is the area where the plantar veins lie on the quadratus plantae and are covered by a leaf of deep plantar fascia. This anatomy is similar to topography of posterior tibial veins., Conclusion: Foot perforator veins constitute the neurovascular bundles as a rule. Plantar vein topography and their relationship with PV confirm an existence of muscular-venous pump of the foot.

The study involved 97 patients with severe diabetic foot syndrome (DFS) subcompensated type 2 diabetes. All patients were available mediacalcification foot and lower leg arteries of different severity. Depending on the treatment, all patients were divided into 2 groups by stratified randomization. The І group received standard therapy, which is indicated for the DFS. A ІІ group of patients additionally received basic therapy drug Cytoflavin 10 ml 0,9% NaCl 200 ml for 10 days, followed by transfer to tablet form Cytoflavin 2 tablets 2 times per day orally for one month. We noted a positive trend of treatment of patients who, in addition to standard therapy received the drug Cytoflavin. Thus, the use of complex surgical treatment of patients with mixed form of DFS Cytoflavin reduces the severity of distal polyneuropathy, improves oxygenation of tissues and restores the enzyme activity of antioxidant system, that manifested neuroprotective, antioxidant and anti-hypoxic effects of drugs, which substantiates the indications for its use in the this pathology.

The authors assessed perfusion of the foot in patients presenting with lower limb critical ischaemia before and after endovascular revascularization, as well as analysed the interrelationship between the change of perfusion and the clinical result of treatment. The study includes a total of 15 patients presenting with ulcerative-necrotic defects of the foot. All patients underwent study of 2D-perfusion of the foot before and after the endovascular intervention. The '2D-perfusion' package was used within the framework of an angiographic examination, and required neither increase in the volume of the contrast medium nor radiation load. Four parameters of perfusion were evaluated: the time of ingress, the time of reaching the peak value, the peak value and the area under the curve. After the intervention, as compared with the baseline values there were statistically significant differences by the time of ingress (a 2.4-fold decrease; p<0.0001), the peak value (a 1.8-fold increase; p<0.0001) and the area under the curve (a 2.4-fold increase; p<0.0001). No statistically significant differences were revealed while comparing the time of reaching the peak value before and after the intervention (p=0.767). Trophic defects healed in 11 (73.3%) patients, and in 4 (26.7%) patients the process of healing continued with positive dynamics at the check-up examination. Hence, our first experience of using the assessment of 2D-perfusion demonstrates simplicity of the method with no increase of the radiation load and the dose of the contrast medium. The method makes it possible to obtain important data about the state of microcirculation of the foot in patients with lower limb critical ischaemia, to evaluate alterations after the endovascular intervention. Improvement of the parameters of perfusion is associated with a good clinical outcome.

The data concerning the anatomy of perforant veins of the foot can by no means be referred to as insufficiently known. At the same time, these descriptions are encountered rather rarely in the educational-and-methodical literature. To a certain degree, this may be explained by low pathogenetic significance of perforant veins of the foot; however, these data are required for the surgeon in carrying out both standard phlebectomy and sclerotherapy of subcutaneous varicose veins, especially if the zone of surgical intervention is situated immediately on the foot. Also, these data may be important for explaining clinical manifestations of chronic venous insufficiency. The present study was aimed at specifying the anatomical ground of formation of the corona phlebecatica and topography of perforant veins of the foot. The material for the study consisted of 15 lower extremities (cadaveric material) with no evidence of chronic venous diseases. The method of the study - anatomical dissection. From 4 to 6 perforant veins were found on the medial surface of the foot. They directly connected the medial marginal vein and vv. plantaris medialis. From 2 to 3 perforant veins were found on the lateral surface of the foot. They connected directly the lateral marginal vein and vv. plantaris lateralis. Topographically perforant veins pass behind the muscles of the lateral group of the foot, along the lateral intermuscular septum. Perforant veins of each group were found to have lateral affluents part of which independently drained the integumentary tissues of the lateral surfaces of the foot, and part formed anastomoses with the superficial venous plantar net. This makes it possible to characterize perforant veins not only as anastomoses connecting subcutaneous rear venous net with deep veins of the foot and with the superficial plantar net, but also as independently draining vessels. Besides, in the majority of cases, nearby a perforant vein we managed to isolate an artery and a nerve branchlet, originating from a. plantaris and n. plantaris. Hence, perforant veins of the medial and lateral surfaces of the foot constitute the anatomical ground for formation of the corona phlebectatica and are component parts of the neurovascular bundle (vein-artery-nerve).

The authors report a clinical case concerning successful endovascular treatment for subacute thrombosis of crural and plantar arteries in a patient with the only leg, substantiating therapeutic decision making with due regard for the duration of thrombosis and localization of the lesion of the arterial bed. Taking into consideration the statistical data on survival in case of performing major amputation in this cohort of patients, an 'aggressive' endovascular approach including three vascularizations made it possible not only to preserve the leg but also to save the patient's life.

It was analyzed the results of examination and treatment of 217 patients with neuro-ischemic form of the diabetic foot syndrome. Diabetic macroangiopathy with critical limb ischemia (TASC II) was diagnosed in all patients. Tissue foot damage of grade 3 (Wagner) was observed in 100 (46.1%) patients, grade 4 - in 117 (53.9%) patients. The developed strategy of surgical treatment includes the revascularization of an affected limb, surgical management of a pyo-necrotic focus and the plastic reconstruction of the foot after rapid relief of ischemia symptoms. An application of such treatment strategy led to preserve a foot or a stump of the foot in 205 (94.5%) patients.

Analysis of the microcirculation indices in 246 patients, suffering diabetic foot syndrome (DFS), was presented. For a neuropathic form of DFS characteristic is lowering of the arterioles tone and enhancement of the blood volume in them, witnessed by raising of constant component of the blood flow. General worsening of perfusion is caused by lowering of endothelial secretion activation, and as well as neurogenic and myogenic control mechanisms. Occurrence of neurogenic regulation disorder is witnessed by the neurogenic oscillations lowering, the neurogenic and myogenic tone raising. In ischemic form of DFS there was noted the perfusion disorder, connected with reduction of the arterial inflow volume. The indices changes witness the disorder of sympathetic regulation of microcirculation and arteriole-venular reactions. The change of the perfusion indices, caused by a congestion processes in arterioles and venules, is characteristic for the mixed form of DFS. The perfusion control mechanisms was noted, as a consequence of the endothelial secretion lowering and the neurogenic and myogenic mechanisms activation of a control. The neurogenic and myogenic tone raising occurs depending on the sympathetic component activity, causing the arterioles diameter reduction.

There were presented the anatomical substantiation, surgical technique of the flap mobilization, the methods for the flaps survival capacity enhancing, as well as the first experience of plasty, using fasciocutaneous flaps of the ankle on a distal nutrating pedicle with a double axial blood supply. The flaps were successfully used for the treatment of durably nonhealing wounds of the foot and the ankle in 23 patients.

The efficacy of the percutaneous transluminal balloon angioplasty in patients with critical ischemia of the lower limbs and diabetes mellitus was analyzed. The study included 102 patients with septic complications of the diabetic foot syndrome. The main group consisted of 37 patients, who received both the traditional conservative therapy and the endovascular angioplasty. The study proves that the endovascular interventions by diabetic foot syndrome are effective and justified. Revascularisation permits the minimal resectional interventions on the foot, stop the ischemia and minimize the number of repeated necrectomies and high amputations. The diabetic foot syndrome is represented as a multidisciplinary problem.

Objective: assessing the incidence rate of atypical anatomical variants of the development of the popliteal artery and plantar arteries according to the findings of digital subtraction angiography., Material: Retrospective analysis of angiograms of 2,456 lower limbs in 1,305 patients. The character of the arterial lesion and the quality of the angiograms allowed of evaluating the anatomy of the popliteal artery and plantar arteries on a total of 1,609 extremities (65%)., Results: The incidence of atypical ramification of the popliteal artery amounted to 9%. Altered blood supply of the foot was observed in 7.6% of cases. The total incidence rate of atypical anatomical variants in men and women did not differ significantly. In the presence of a typical anatomical variant on one extremity, the prevalence of atypical blood supply of the other limb amounted to 16.3%. In the presence of an atypical anatomical variant on one limb, the incidence of atypical blood supply of the other amounted to 42%. In case of atypical blood supply of the foot on one limb, the incidence rate of the same-type abnormality on the other equalled 48%., Conclusion: In a typical variant of blood supply of one extremity, the probability of typical blood supply of the other amounted to 83 .7%, in an atypical variant decreasing to 58%. In case of atypical blood supply of one foot, one should suppose an analogous anatomical variant on the other foot in half of the cases.

Treatment results of 203 patients with critical ischemia by neuroischemic form of the diabetic foot sindrome were analyzed. 45 patients had open, endovascular or hybrid vascular reconstructions. The method was decised basing on the results of angiographic studies. The support function was saved in 34 (75,6%) cases of 45 operated patients. Revascularization proved to be an effective and reasonable method of surgical intervention by critical ischemia caused by the neuroischemic form of the diabetic foot syndrome.

Pathogenetic parameters of abdominal and mesenchymal sepsis, traumatic and burn shock, acute pancreatits, ischemic-reperfusion syndrome by renal transplantation, blood flow restoration by reconstructive cardiac surgery, critical limb ischemia in patients with obstructive vessel diseases etc., such as endotoxicosis, cytokinemia, biochemic changes, laser Doppler flowmetry indexes and morphologic signs of tissue necrosis were analyzed. The study proved the pathophisiological universatility of ischemic-reperfusion syndrome as a generated evolutionally and genetically encoded response to superagression, such as iatrogenic blood flow restoration.

Presented herein is a clinical case report of a male patient suffering from ischaemic gangrene of the foot on the background of an atherosclerotic-genesis multifocal occlusive-and-stenotic lesion of the major arteries of the lower extremities and undergoing programmed haemodialysis for terminal-stage chronic renal insufficiency. The patient was successively subjected to three-stage surgical management, with the first stage consisting of revascularization of the extremity involved by means of "in-situ" femoropopliteal auotovenous bypass grafting, the second comprised resection of the calcaneum with the removal of the osteomyelitis focus, and the third one was composed of dermatoautoplasty of the defect of the foot with a split cutaneous flap.

The authors have studied the findings of the examination of and therapeutic outcomes in a total of one hundred and thirty-one patients diagnosed with atherosclerotic-aetiology stage IV chronic arterial insufficiency of the lower extremities. Of these, the dynamic analysis of the tissue blood flow on the background of haemodynamically efficient direct revascularization of the lower limbs was carried out in ninety-six patients. In a further 35 patients, a comprehensive instrumental examination of the blood flow on the background of chronic critical ischaemia was complemented by evaluating the morphological alterations in the skin of the foot of the affected extremity. The findings obtained during the examination made it possible to single out three types of morphofunclional alterations in the micro-circulaiory bed (i. e., irreversible, severe reversible, and moderate), as well as to trace the patterns of transformation of the tissue blood flow in each of them on the background of efficient direct revascularization.

Much effort has been made in searching for multipotent cell types with high therapeutic potentials for repair of damaged tissue. Through enzymatic digestion of fat tissue, it is possible to obtain a large number of stromal cells. Isolated cells show a high proliferate capacity in culture. All this makes adipose stromal cells (ASC) promising candidates for their use in cell therapy. This review is focused on analyzing the surface antigen profile of isolated population of ASC, expression of angiogenic factors by these cells, as well as on their differentiation potential. A high percentage of ASC population initially express the progenitor cell marker CD34, but during culturing, cells exhibit a mesenchymal cell phenotype and express CD29, CD105, CD106, CD166. Culturing ASC in specific differentiation media induces expression of early markers of differentiated mesenchymal cells, such as adipocytes, chondrocytes and osteoblasts, as well as myoblasts, cardiomyocytes and neural cells. It has been also shown that ASC have a strong pro-angiogenic potential, they are able to secret growth factors, such as VEGF, HGF, bFGF and others, which stimulate survival and proliferation of endothelial cells. In addition, systemic or local delivery of ASC to mice with hindlimb ischemia stimulates recovery of injured tissue and blood flow. Potential clinical uses of ASCs are discussed in the review.

Analysis of data on the treatment of 100 patients with purulent-necrotic forms of diabetic foot syndrome is presented. Patients were divided into two groups. In the first group (45 patients) treatment was conducted using traditional methods and techniques. In the second group (55 patients) during operation air-plasma cutting-coagulation device "Plazon" was used in NO-therapy mode. Nitric monoxide is known as multifunctional antioxidant substance, having great value in oxidative stress reactions. In the current study it was transported to the wound surface by air-flow of "Plazon" device. The condition of microcirculation in tissues was studied by computerized laser capillary flow analyzer "LAKK-01". It was shown that after removing inflammation in the healed wound, condition corresponding to characteristics of undamaged skin takes place in contrast to the patients from the group 1, where some asymmetry in the foot tissues microcirculation was shown as an evidence of functional and structural insufficiency of microcirculation system.

There were analyzed the results of surgical treatment of 246 patients, suffering diabetes mellitus, with destructive forms of the diabetic foot syndrome. It was established, that application of an active surgical tactic using cutaneo-adipose flap of their own and cellular culture of fibroblasts on the background of selective prolonged intraarterial complex therapy permits to perform economic amputation of foot, reduces risk of performance of high amputation of the lower extremity and reoperations.

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.

There were analyzed the results of treatment of 75 patients with diabetic angiopathy of the lower extremities and purulent-necrotic affection of the foot tissues, to whom restoration operation on the main vessels was accomplished. In 11 patients aorto-femoral bilateral shunting together with lumbar sympathectomy was performed, in 7--femoro-femoral shunting, in 38--femoro-popliteal, in 12--iliofemoral shunting together with lumbar sympathectomy, in 7--thrombendarterectomy from a. femoris communis in conjunction with the vessel dilatation using the patch. In 89.2% of patients satisfactory result with the extremity preservation was noted. In 10.8% of patients high amputation of extremity was done, all the patients are alive.

Problems of treatment of battle injuries of the ankle joint and foot are discussed. These injuries are characterized with severe disturbances of regional circulation and microcirculation causing hypoxia and metabolic disorders both in soft tissues and in bones. Digital substraction angiography (DSA) was used in 7 wounded (7.53%) of all patients with battle injuries of the foot and ankle joint. Combined treatment including surgery, drugs, physical and exercise therapy, hyperbaric oxygenation was used in all the patients. Prolonged intraarterial infusion of drugs was carried out in 4 of 7 patients. It is concluded that early evaluation of regional circulation permits to clarify expediency of applied combined treatment. Injury of three arteries is the indication for amputation, but even one functioning artery enables use of combined therapy with intraarterial infusion for extremity salvage.

Methods of mathematical modeling in the interests of gravitational therapy revealed a number of specific effects of the short-radius centrifuge (SRC) on human leg vessels. The concepts of local g-loads and local hydrostatic pressure during exposure to the gravitational and inertial forces have been formulated. Experimental data suggest a squared dependence of local hydrostatic pressures (including in the pathology focus) on the radius of rotation; extra asymmetric oscillations of main vessels, point to the effects of the Coriolis acceleration of blood on vascular walls.

The authors describe the results of treatment of 245 patients with pyo-necrotic diseases of soft tissues with a new proteolytic enzyme of vegetable origin Kukumazim. The application of Kukumazim resulted in a 5-6 days shorter period of complete healing the wounds. No adverse effects of using Kukumazim were noted.

Results of treatment of 93 patients with diabetes mellitus and occlusive-stenotic affection of arteries of femoro-popliteal and popliteal-tibial segments were analyzed. Indications for performance of operation were established, basing on analysis of clinical manifestations of the disease and results of instrumental methods of investigation. Femoro-popliteal autovenous shunting performed in 47 (50.5%) patients, endarterectomy from the same segment--in 26 (28%), roentgenoendovascular dilatation of segments of femoral superficial and popliteal arteries--in 11 (11.8%), popliteal-tibial autovenous shunting--in 9 (9.7%). In 84 (90.4%) of patients succeeded to preserve the extremity. Postoperative lethality was 4.3%. Passability of autovenous femoro-popliteal-tibial shunts during 5 years was noted in 49.5%, passability of arteries after endarterectomy--in 38.7% of observations.

In order to decrease the number of amputations for "diabetic foot", these patients should undergo elective or delayed operations. It is obligatory before the operation to correct carbohydrate metabolism and hemodynamics. Sodium succinate in combination with conventional angioprotective treatment is used for this purpose. Microcirculation is evaluated using oxymonitor ISM-2 and tetrapolar rheography. Blood flow disturbances are evaluated according to ultrasound dopplerography data. Operations are performed with the use of a primary or delayed suture at the definite level of the extremity where oxygen tension of the skin is not lower than 33 mm Hg, and the index of minute blood flow--not lower than 1.8 ml/min per 100 cm3 of the tissue. When operating on the foot it is obligatory to leave loose excessive brims of tissues to facilitate the placement of broad-grip sutures without tension. It is advisable to use through flowing--aspiration drainage and to perform surgical treatment of the deep phlegmon of the foot through club-shaped approach.

The method of phlebotonometry developed by the authors was used in an analysis of results of the state of musculo-venous pump of lower extremities and pelvis in 106 patients with varicose disease. The dynamics of phlebotonogram indices was studied during isolated functional exercises of the muscles of prelum abdominale, femur, leg and foot. In the first and second stages of the disease the function of both the single pumps and the whole pump system is disturbed but mildly and has no stage distinctions. Their pronounced impairment appears but in cases of a complicated course of the disease. In valvular incompetence of deep veins the musculo-venous pump looses its function: the greater the degree of valvular incompetence, the worse the functioning of this structure.

An examination and following treatment of 469 patients with varicose disease were carried out on the basis of a three-steps noninvasive diagnostic complex developed by the authors of the article. The first step is intended for examining the patients in order to detect injuries of each of the four pumps (the abdomino-caval pump, femur, shin and foot) involved in the venous return. The functional tests developed by the authors were used. The second step included the determination of the degree of injury of the pumps under study with the help of functional rheovasography of the femur, shin and foot. Methods of ultrasonic dopplerography were used at the third step for detecting the causes of the developing blood refluxes.

An examination of 91 patients with varicosities of the lower extremity veins at different stages of the disease was carried out in order to find out the retrograde blood flow in deep veins of the shin and foot by means of the retrograde popliteal and talocrural phlebography. The investigation performed allowed a conclusion of an important pathogenetical role of the retrograde blood flow in deep veins of the shin and foot in genesis of trophic cutaneous disorders. Endovascular occlusion of the posterior tibial veins after A.N. Vedensky was fulfilled in 32 patients with trophic cutaneous disorders along with a correction of the pathological blood flow along the superficial veins. An analysis of long-term results of the treatment has shown that this kind of operative interventions is an adequate method for correction of the hemodynamic disorders in question at the decompensation stage of the disease.

16 patients with insulin-dependent diabetes mellitus (IDDM) lasting 8-19 years had pronounced diabetic nephropathy (proteinuria stage), retinopathy (stage I, II or III), disturbed circulation in the lower limbs detected at foot dopplerography. For 3 months these patients received ibustrin (inhibitor of cyclooxigenase, blocker of tromboxane A2 synthesis and platelet aggregation) before renal function underwent positive changes: glomerular filtration rate increased in 13 patients (81%), 24-h proteinuria decreased in 12 patients (75%). Retinal vascular condition improved in 5 of 6 patients with nonproliferative retinopathy and in 2 of 5 patients with preproliferative retinopathy, in 1 and 3 patients stabilization occurred, respectively. In proliferative retinopathy improvement and stabilization were registered in 1 and 3 of 5 patients, respectively. According to feet artery dopplerography the improvement, no changes and moderate aggravation occurred in 10(62%), 3(19%) and 3(19%) of patients, respectively The conclusion is made that ibustrin effectively inhibits progression of IDDM vascular complications, especially at early angiopathy stages.

120 patients with Guillain-Barre syndrome and other peripheral myelinopathies were randomly assigned to three treatment groups. One of the group was exposed to pulsed high frequency electric field (47 patients), the other group to continuous current (52 patients), and the third group received the imitation of therapy (21 patients). Pulsed current therapy caused the greatest regress of the neurological deficit (45 from 47 cases). The electroneuromyography of paretic limbs nerves showed that the acceleration of remyelinization process turn to be the background of pulsed high frequency electric field medical action. Both the rheovasography and isotope muscle flow measurements did not confirm the hypothesis about preferential mediation of the healing potency of pulsed short wave diathermy through vascular mechanism. It was suggested the direct influence of pulsed short wave diathermy on protein synthesis process in the spinal alpha-motoneurone and myocyte.

An analysis of the complex clinical and phlebographic examination of 84 patients with the varicose disease was made. Eight variants of the state of the valve apparatus of profound veins of the foot were established. Main regular features of spread of the retrograde blood flow the profound veins along insufficient perforating to the superficial veins were determined. A classification of incompetence of the valve apparatus of the profound veins of the foot was developed which allows the choice of surgical procedures depending on the injury degree.

The functional state of foot musculo-venous "pump" was studied with the help of distal and retrograde phlebography. rheovasography and phlebotonometry in 148 patients with varicose disease. The authors suggested that in the base of its dysfunction lies the foot deep vein ectasis and the varicose insufficiency of communicating veins connected with them.

By means of angiography, made in 20 patients with rigidity of the first toes due to osteoarthrosis, there have been revealed chronic deficiency of blood circulation in the foot tissues, especially in its antero-internal section. Blood circulation deficiency is due either to the congenital anomaly of the foot vessels or to the consequences of their traumatic injuries. Blood supply deficiency results in degenerative-dystrophic changes of the first metatarsophalangeal articulations with development of their rigidity, aggravated by post-ischemic contracture of the foot muscles.

Raynaud's phenomenon is a pathological condition with a multicomponent pathogenesis characterizing the community of mechanisms of the reactivity of the terminal microvessels of the extremities in response to standard stimulation. Raynaud's phenomenon is not a nosological form. In discovering Raynaud's phenomenon, however, differential diagnosis must be conducted to recognize the disease which caused the phenomenon. The diagnosis of Raynaud's disease, which is a nosological form, can be established by the method of exclusion of all such diseases. Raynaud's syndrome in the existence of diseases which are the primary cause is merely a precise diagnostic formulation.

++Thermo-topography was studied by decimeter radiothermometry on a DPT-30 apparatus which determined the integral ++sub-superficial temperature of a tissue layer at a depth of 3-5 cm. Thermal probing was performed at point 41 onto the dorsal and ventral surfaces of the human body. Hemodynamics was explored by tetrapolar thoracic rheography. A total of 83 young healthy males were studied. Associated changes in temperatures and hemodynamic parameters were established. The radioluminance thermal profile of patients with tachycardia was significantly altered as compared to those with bradycardia. The ++sub-superficial temperatures in the proximal regions of the body rose by 0.3-0.7 degree C. The feet in subjects with rapid pulse were colder, which led to significantly higher values of distal and proximal lower extremity, temperature gradients. In persons with hyperkinetic circulation, the temperatures in the ++cranio-corporeal regions were significantly greater by 0.2-0.6 degree C than those in subjects with eu- and hypokinetic circulations.

As many as 39 patients with psoriatic arthritis were examined for hemorheology. Of these, 20 were examined at a time for the status of the microcirculatory bed in the skin and skeletal muscle by 133Xe clearance from the interstitial depot and by laser-Doppler flowmetry at the areas of the clinically intact skin. In 10 patients, the plasma blood viscosity was measured. All the test subjects manifested the clinical signs of damage to the vessels of the microcirculatory bed, namely capillaritis of the palmar surface of the hands and/or of the plantar surface of the feet, sensitivity to cold, numbness of the finger tips. A detailed analysis of the individual aggregation characteristics allowed two groups of patients to be revealed: with a decrease and enhancement of aggregation at a shift rate of 2.5 s-1. It should be noted that patients with severe hemorheological disorders showed both changes on the part of the microcirculatory bed (clinical and quantitative) and a rise of the blood plasma viscosity and hematocrit fall. The data obtained indicate that the microcirculatory and related rheological disorders may be implicated in the pathogenesis of psoriatic arthritis.

The authors have thoroughly studied the versions of anatomic structure, peculiarities of blood circulation and innervation of lateral arm graft at 20 recent cadavers. The graft can be utilized in different modifications; cutaneofascial, subcutaneofascial, musculocutaneous, osteocutaneous. In the clinic were made 8 free microsurgic transplantations of lateral arm graft for plasty of tissues of different genesis in functionally important zones of hand and foot. In long-term post-operative period all patients demonstrated good functional and cosmetic results.

The article analyses 32 clinical cases with severe ischemia in patients with occlusion of the leg and foot arteries, which was treated by arterialization and reversion of the venous blood flow in the outlets of the great saphenous vein. The operative techniques are described in detail. The complications occurring after arterialization of the venous blood flow of the foot are analysed and reliable methods for their prevention and treatment are suggested. Circulation was compensated 2 years after arterialization in 25 among the 32 patients who were operated on, which points to the high efficacy of this operation in occlusion of the distal arterial channel.

The results of thermographic studies of the limbs of patients suffering from diabetes mellitus of different severity and duration are presented. Thermogram changes expressed by IR-radiation decrease in the foot and hand distal regions or "amputation" thermograms of feet and hands are characteristic of peripheral microangiopathy. Thermoasymmetry is more typical of the arterial atherosclerotic affection. The use of nitroglycerin test allows one of differentiate functional and organic vascular injuries and to judge the compensation of peripheral circulation.