In March 2020 I was in the Ulm University Clinic for 2 weeks. My internship course took place on the basis of the department of general and visceral surgery. The work in the clinic is structured in such a way that not only surgeons but also doctors of the adjoining specialties, trainees and students participate in the discussion of patients’ treatment. And at the morning conferences, a resuscitator, a radiologist and an endoscopist must always be present. The operating unit has all necessary equipment in sufficient quantity. Preoperative preparation is carried out by the anesthetic team in the preoperative room. A special role is given to the patient’s thermal isolation using special blankets, protection of the patient’s eyes with a patch, and perioperative antibiotic prophylaxis. In addition to the operating surgeon and two main assistants, the operating team obligatorily includes a student. Continuous training by senior surgeons of junior ones is practiced. Basic surgical instruments are represented with everything you need. In the postoperative period all drugs are charged into infusion machines at a daily dosage, which simplifies the work of paramedical personnel and also reduces the risk of catheter infection. When entering a medical university the competition is initially very high (more than 20 people per place). All doctors work in a unified team, there is no strict division into university chairs and clinic departments. Two weeks spent in the Ulm University Clinic have shaped my understanding of medical care and medical education in Germany, acquainted me with the specificity of the surgical service and the technical features of performing surgical interventions.

Background. The Global Vascular Guidelines (2019) proposed the term “critical limb-threatening ischemia”, which leads to death or amputation within 12 months. Only half of the patients undergo limb revascularization; the rest receive conservative treatment, the effectiveness of which is extremely low. In this regard, it is necessary to develop alternative methods of surgical treatment based on the use of cellular technologies. Aim. To evaluate the clinical efficacy of revascularizing automyelotransplantation in the complex treatment of patients with chronic wounds associated with diabetic angiopathy of the lower extremities. Material and methods. The study included 100 patients suffering from diabetic angiopathy of the lower extremities and diabetes mellitus type 2. Chronic wounds of the lower extremities were detected in 25 patients of the main group and 32 patients in the comparison group. The size of chronic wounds in the main group before the start of treatment ranged from 0.5 to 3.5 cm2 (median (Me) 2.1 [1.5; 2.5] cm2), in the comparison group it varied from 0.7 to 3.5 cm2 (Me 2.1 [1.7; 2.6] cm2). There were no statistical differences between the groups (pMann-Whitney=1.0). Results. In the main group, chronic wounds healed in 12 patients (48%), decreased in size in three cases and remained without dynamics in one case. In six patients the purulent-necrotic process progressed, which led to amputation of the limb at the hip level. Three patients died. Among 32 patients with chronic wounds in the comparison group healing of chronic wounds or reduction in their size were not observed. In 10 people, the size of the defects did not change; in seven cases the purulent-necrotic process progressed, which led to the amputation of the limb. In two patients chronic wounds occurred after hospitalization. Fifteen patients died. The article presents descriptions of clinical cases. Conclusion. The use of revascularizing automyelotransplantation in the complex treatment of patients with diabetic angiopathy of the lower extremities has a positive effect on the dynamics of the wound process in chronic wounds.

The lesion of the lower extremities vessels is one of the most dangerous complications of diabetes mellitus. The prognosis is bad in case of the development of critical ischemia.The aim of the study is to assess the effect of autological red bone marrow aspirates on the microcirculation in the soft tissues of the lower extremities of patients with diabetic angiopathy.The study included 36 patients with diabetic angiopathy of the lower limbs. The main group of 20 people consisted of the patients, whose treatment was added by revascularizing automyelotransplantation. The comparison group (16 people) included the patients who received standard complex conservative treatment.All patients underwent pulse oximetry on the 1st toe before the treatment start and within the control times. The painless walking distance was also assessed and the chronic arterial insufficiency stage was determined.In the main group, 18 patients retained their lower limbs, in the comparison group - 10 patients (pCox-Mantel = 0.015).There was an increase in the painless walking distance in 15 out of 18 patients in 3-6 months after treatment in the main group. There was no improvement in the comparison group. Chronic wounds healed in 4 out of 7 patients.The median SpO2 in the main group was 96 [92; 97] %, in the comparison group - 90 [88; 92] % (pMann_Whitney = 0.0035).The inclusion of revascularizing automyelotransplantation in the complex treatment of patients with diabetic angiopathy of the lower extremities contributes to the lower extremity preservation, as well as the relief of critical ischemia signs and the healing of chronic wounds.