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

• Main Authors: Guangwei Liu, Shanlang Li, Xiaocong Kuang, Jia Zhou, Zhaowei Zhong, Yi Ding, William Lu, Jinmin Zhao, Yan Chen, Qikai Hua
• Format: Article
• Language: English
• Published: Elsevier 2020-11-01
• Series: Journal of Orthopaedic Translation
• Subjects: Chronic ischemic disease; Diabetic foot ulcer; Distraction angiogenesis; Ilizarov technique; Peripheral artery disease; Tibial cortex transverse transport
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214031X20301133

Chronic limb ischemic diseases are characterized by symptomatic reduced blood supply to the limbs and can develop into limb-threatening ischemia which is difficult to manage. Distraction osteogenesis induces a large volume of new bone and neovascularization in the surrounding tissues. Consequently, the transverse distraction of tibia has been applied to the management of thromboangiitis obliterans, a chronic limb ischemic disease. However, the application of this technique is still infrequent. Recently, we developed a new technique and coined the term tibial cortex transverse transport (TTT) for it and applied it to severe and recalcitrant diabetic foot ulcers and atherosclerosis obligation and attained excellent clinical outcomes. This review discusses recent advances in the technique of TTT, its application to chronic limb ischemia, the underlying mechanisms, and its potential new clinical applications. The translational potential of this article: TTT has shown promise for the treatment of chronic limb diseases such as diabetic foot ulcer, Buerger’s disease, and arthrosclerosis obliterans in retrospective clinical studies. Its new clinical applications are probably to be extended into the management of other chronic limb diseases such as ulcers of venous, traumatic, embolic, or nonatherosclerotic etiologies, wounds left after tumor resection, radiation, or chemotherapy therapy, or infectious or inflammatory diseases. The surgical procedure is relatively simple and the complications are few and minor. Nevertheless, its effectiveness and safety needs to be confirmed in large population-based trials, and its indications and contraindications are also to be clarified. Additionally, more basic and clinical studies are required to illustrate the underlying mechanisms.