The emerging role of tibial cortex transverse transport in the treatment of chronic limb ischemic diseases

Liu, Guangwei; Li, Shanlang; Kuang, Xiaocong; Zhou, Jia; Zhong, Zhaowei; Ding, Yi; Lu, William W.; Zhao, Jinmin; Chen, Yan; Hua, Qikai

doi:10.1016/j.jot.2020.10.001

Cited by 11 publications

(13 citation statements)

References 27 publications

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“…However, approximately 40% of patients cannot undergo vascular surgery due to complete occlusion of small blood vessels in the lower extremities. Based on the stress-tension principle of the Ilizarov [ 7 ], many Chinese researchers and doctores invented a technique called tibial transverse transport (TTT) to restablised the microcirculation of lower limb to cure the DFU which could improve the ulcer cure rate up to 96% [ [8] , [9] , [10] ].…”

Section: Introductionmentioning

confidence: 99%

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

Yuan

Ding²,

Jing

et al. 2021

Journal of Orthopaedic Translation

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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.

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Section: Introductionmentioning

confidence: 99%

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

Yuan

Ding²,

Jing

et al. 2021

Journal of Orthopaedic Translation

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“…Tibial transverse transport is a new method for the treatment of diabetic foot ulcers based on the Ilizarov stress tension law that has recently been proposed. Many retrospective studies have reported that the effective rate of TTT in the treatment of diabetic foot ulcers was >90% 8,13–15 . Research has shown that after treatment, the proliferation of vascular endothelial cells, formation of new capillaries and arterioles could be observed around the bone flap, and collateral circulation was formed at the end of the lower limbs 7 .…”

Section: Discussionmentioning

confidence: 99%

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

Ding

Yuan

Lü

et al. 2022

Orthopaedic Surgery

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Objective To explore the efficacy of antibiotic bone cement (ABC) combined with the modified tibial transverse transport (mTTT) on the treatment of severe diabetic foot with infection. Methods A retrospective cohort study was conducted of 243 patients with TEXAS grade 3/4 stage D diabetic foot ulcers from December 2016 to December 2019. A total of 115 patients treated with mTTT were classified as the mTTT group (78 male and 37 female, mean age: 70.4 ± 6 years) and 128 patients who were treated with ABC combined with mTTT were in the ABC + mTTT group (89 male and 39 female, mean age: 68.9 ± 8 years). Follow‐up records during treatment and 6 months after surgery were collected, including the time required for white blood cells (WBC) and C‐reactive protein (CRP) to return to normal range, wound healing time, pain visual analog scale (VAS), ankle‐brachial index (ABI), foot skin temperature, transcutaneous oxygen pressure measurement (TcPO2), complications, and other indicators. Normally distributed data were compared using the independent sample t‐test, non‐normally distributed data were analyzed by one‐way ANOVA analysis of variance. Results There were 128 cases in the ABC + mTTT group (89 male and 39 female, mean age: 68.9 ± 8 years) treated with ABC and mTTT, and 115 cases in the TTT group (78 male and 37 female, mean age: 70.4 ± 6 years) treated with mTTT alone. The time required for WBC and CRP to return to the normal range and wound healing time in the ABC + mTTT group were significantly shorter than those in the mTTT group (12.9 ± 4.6 vs. 22.6 ± 1.6 days, t = 3.979, p < 0.001; 25.3 ± 1.3 vs. 31.3 ± 2.3 days, t = 4.261, p = 0.001; 11.9 ± 3.8 vs. 15.9 ± 3.9 days, t = 4.539, p < 0.001). There were no significant intergroup differences in the foot skin temperature, VAS score, ABI, and TcPO2 (t = 0.349, 0.542, 0.765, 0.693 while all p > 0.05). Conclusion Although the application of ABC with mTTT for treatment of diabetic foot ulcers did not affect the wound healing time and ankle blood supply in the mid‐term, it could control ulcer infection faster and accelerate wound healing.

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“…One of the newest editions is the Journal of Orthopaedic Translation of the Chinese Speaking Orthopaedic Society (CSOS) and the International Chinese Musculoskeletal Research Society (ICMRS) which main goal is to publish papers that “identify and fill scientific knowledge gaps at the junction of basic research and clinical application (from bench to bedside) or community application (from bench to community)”. It published 16 articles on the application of the techniques based on the Ilizarov method and basic research in a special issue (November 2020), titled Ilizarov Techniques in China for 30 years: From Research to Clinical Translation that focuses on shortening of treatment duration by stimulating distraction histogenesis[ 135 , 137 ].…”

Section: The International Impact Of the Ilizarov Methods On The Evolution Of Bone Reconstruction Surgerymentioning

confidence: 99%

“…On the contrary, the role and significance of craniomaxillofacial distraction procedures have been much discussed in the specialized literature and has been found applicable in craniofacial deficiency or dentofacial anomalies that are corrected with distraction procedures and special devices[ 132 , 133 ]. Another Ilizarov’s idea of stimulating the vascularity in chronic ischemic diseases in the lower extremities has been revived and its modification has been called tibial transverse distraction[ 134 , 135 ].…”

Section: Current Clinical Practice and Research In The Ilizarov Techniques Of Bone Reconstructionmentioning

confidence: 99%

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100^thbirthday of G. A. Ilizarov)

Malkova

Borzunov

2021

WJO

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The Ilizarov method is one of the current methods used in bone reconstruction. It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA. Its main merits are viable new bone formation through distraction osteogenesis, high union rates and functional use of the limb throughout the course of treatment. The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery. Since then, the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails. They gave rise to a relatively new orthopedic subspecialty termed “limb lengthening and reconstruction surgery”. Based on a comprehensive literature search, we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community. The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating. The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents. It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.

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The emerging role of tibial cortex transverse transport in the treatment of chronic limb ischemic diseases

Cited by 11 publications

References 27 publications

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

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

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

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100^thbirthday of G. A. Ilizarov)

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The emerging role of tibial cortex transverse transport in the treatment of chronic limb ischemic diseases

Cited by 11 publications

References 27 publications

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

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

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

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100thbirthday of G. A. Ilizarov)

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International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100^thbirthday of G. A. Ilizarov)