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

作者：Yan Chen, Xiaofang Ding, Yueliang Zhu, Zhongwei Jia, Yong Qi, Mingyong Chen, Jili Lu, Xiaocong Kuang, Jia Zhou, Yongfeng Su, Yongxin Zhao, William W. Lu, Jin-min Zhao, Qikai Hua · 发表于：Journal of Orthopaedic Translation · 年份：2022 · DOI：10.1016/j.jot.2022.09.002 · 被引用次数：51 · 研究领域：Diabetic Foot Ulcer Assessment and Management、Bone fractures and treatments、Reconstructive Surgery and Microvascular Techniques

Management of recalcitrant diabetic foot ulcer (DFU) remains difficult. Distraction osteogenesis mediates new bone formation and angiogenesis in the bone itself and the surrounding tissues. Recently it was reported that tibial cortex transverse transport (TTT) was associated with neovascularization and increased perfusion at the foot in patients with recalcitrant DFUs and facilitated healing and limb salvage. However, the findings were from several single-center studies with relatively small populations, which need to be confirmed in multicenter cohort studies with relatively large populations. Furthermore, the effect of this technique on patient's health-related quality of life is still unclear. We treated patients with recalcitrant (University of Texas wound grading system 2-C to 3-D and not responding to prior routine conservative and surgical treatments for at least 8 weeks) DFUs from seven centers using TTT (a 5 cm × 1.5 cm corticotomy followed by 4 weeks of medial and lateral distraction) between July 2016 and June 2019. We analyzed ulcer healing, major amputation, recurrence, health-related quality of life (physical and mental component summary scores), and complications in the 2-year follow-up. Foot arterial and perfusion changes were evaluated using computed tomography angiography and perfusion imaging 12 weeks postoperatively. A total of 1175 patients were enrolled. Patients who died (85, 7.2%) or lost to follow-up (18, 1.7%) were excluded, leaving 1072 patients for...