The Effect of Modified Tibial Transverse Transport Technique in the Treatment of Wagner Grade Ⅲ and Ⅳ Diabetic Foot Patients

Abstract

Background Diabetic foot is a serious chronic complication of diabetes, tibial transverse transport (TTT) technique can promote the regeneration of vascular tissue, improve microcirculation, achieving good results in the treatment of diabetic foot ulcers, but traditional TTT technique has many complications, which needs to be improved to reduce postoperative complications. Objective To investigate the efficacy of modified TTT technique, that is, bone and periosteum combined transport technique, in the treatment of patients with Wagner grade Ⅲ and Ⅳ diabetic foot. Methods The clinical data of 117 diabetic foot patients treated with modified TTT technique in the hand and foot surgery of Yantai Yuhuangding Hospital from January, 2018 to May, 2021 were retrospectively analyzed, and the postoperative foot preservation, functional limb preservation, large amputation, ulcer healing time, complication, foot skin temperature improvement, resting pain, preoperative and postoperative CTA results were collected. The follow-up was till to March 31, 2022. Result The follow-up time ranged from 5.5 to 24.0 months, with an average of (14.21±4.06) months. The postoperative foot preservation rate (no amputation or amputation below ankle) was 95.73% (112/117) , the functional limb preservation rate (no amputation or minor amputation distal to midfoot) was 83.76% (98/117) , the major amputation rate (amputation above ankle) was 4.27% (5/117) , and the postoperative ulcers healed well in all patients except amputees, with an average time to healing of (9.07±2.02) weeks, ranging from 6 to 14.5 weeks. The postoperative foot skin temperature at 1, 2, 4, and 8 weeks of the patients were significantly improved compared with the preoperative period (P<0.01) ; The postoperative VAS scores of 35 patients with resting pain at 1, 2, 4, and 8 weeks compared with the preoperative period (P<0.01) ; the CTA results showed improved postoperative vascular condition, increased microvascular vessels number and reconstructed vascular network of the foot in 70.34% (94/117) of included patients postoperatively; The incidence of complication during bone handling was 11.97% (14/117) , among which the incidence of osteotomy area skin edge necrosis, deep vein thrombosis, and pin track infection was 5.98% (7/117) , 4.27% (5/117) , and 1.71% (2/117) , respectively. Conclusion The modified TTT technique can promote wound healing through the stimulation of lower limb microcirculation reconstruction, to alleviate resting pain and improve foot skin temperature in diabetic foot patients effectively in the short term, with low incidence of complication, providing an effective approach for the treatment of diabetic foot.

Keywords

• diabetic foot|bone and periosteum combined transport technique|transverse bone transport of the tibia technique|surgical procedures, operative|diabetes mellitus|postoperative complications