Modified tibial transverse transport technique for the treatment of ischemic diabetic foot ulcer in patients with type 2 diabetes

Abstract

Background Ischemic diabetic foot ulcer is one of the terminal complications of diabetes. The high amputation rate, recurrence rate, and treatment cost have caused a huge burden on patients and society. This study designed the modified tibial transverse transport (mTTT) technology to treat diabetic ischemic diabetic foot ulcers in patients with type 2 diabetes and investigated the effectiveness and safety of this technique. Methods This was a retrospective analysis of patients with type 2 diabetes and ischemic diabetic foot ulcers at two hospitals during January 2016–October 2019. These patients underwent mTTT surgery combined with wound debridement and vacuum sealing drainage negative pressure drainage treatment. In-hospital follow-up was performed at 1 month after the operation, while outpatient follow-up was performed at 3, 6, and 12 months after the operation. The ulcer healing time, recurrence rate, major amputation rate, and complications were analysed. Results A total of 201 patients were enrolled in this study, including 107 males and 94 females (mean age: 68.3 ​± ​7.1 years). The wounds of all patients healed completely (mean healing time: 4.6 ​± ​1.6 months). There was no occurrence of major amputation, recurrence, and treatment-related complications in the patients. Conclusion mTTT can effectively and safely treat ischemic diabetic foot ulcers in patients with type 2 diabetes. This technology is an important part of the ischemic diabetic foot ulcer treatment system and warrants further research. The Translational Potential of this Article This study introduced a new method to treat the ischemic diabetic foot ulcer which was called modified tibial transverse transport. The promising outcomes of patients indicated that this surgical method had great potential for clinical application and was worthy of further clinical research with high evidence level.

Effect of tibial cortex transverse transport in patients with recalcitrant diabetic foot ulcers: A prospective multicenter cohort study

“…These therapies are more effective for localized and mild-to-moderate ulcers while with less effects on diffuse, severe, and recalcitrant ulcers, and are linked with high complication and failure rates [ 17 , 18 ]. Recently, a novel surgical technique, tibial cortex transverse transport (TTT), in which partial corticotomy is created followed by medial and lateral distraction, was developed for the treatment of recalcitrant DFUs [ [19] , [20] , [21] , [22] , [23] , [24] ]. This technique is based on distraction osteogenesis in which gradual distraction of osteotomized bone segments results in new bone formation and angiogenesis in the bone itself and the surrounding tissues [ 25 , 26 ].…”

Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up

“…Initially, this traction device was primarily used for closed reduction and fixation of femoral shaft fractures, and achieved good results [ 23 ]. Based on the theory that application of a suitable external compressive stress to the bones could stimulate the natural repair ability of the tissues in the body, the axial traction and transverse pressure of the novel device can lead to the regeneration of bones and other tissues, eventually resulting in the natural reconstruction of the microcirculation and promoting rapid fracture healing [ 24 ]. The result of our study also confirmed that fracture healing time was more shorter in the novel device group than in the ORIF group ( P ​< ​0.001).…”

Analysis of the Effect of Antibiotic Bone Cement in the Treatment of Diabetic Foot Ulcer through Tibia Transverse Transport

“…The detailed surgical procedure can be referred to in a previous article 9 . Two 3.0 Steinmann pins were inserted through the single layer of cortical bone.…”

“…The detailed surgical procedure can be referred to in a previous article. 9 Two 3.0 Steinmann pins were inserted through the single layer of cortical bone. The Steinmann pins were used as the centre point for the drilling on four sides with a 2.0 drill bit and use of a rapid osteotomy device; the length of each side was 1.5 cm.…”