Efficacy and safety of unilateral tibial cortex transverse transport on bilateral diabetic foot ulcers: A propensity score matching study

Wencong Qin; Xinyu Nie; Hongjie Su; Yi Ding; Lihuan He; Kaibing Liu; Jun Hou; Kaixiang Pan; Liexun He; Sijie Yang; Lisha Li; Shenghui Yang; Xiao Peng; Jinming Zhao; Jack Guan; Xiaocong Kuang; Qikai Hua

doi:10.1016/j.jot.2023.08.002

Efficacy and safety of unilateral tibial cortex transverse transport on bilateral diabetic foot ulcers: A propensity score matching study

J Orthop Translat. 2023 Sep 14:42:137-146. doi: 10.1016/j.jot.2023.08.002. eCollection 2023 Sep.

Authors

Wencong Qin^{1

2}, Xinyu Nie^{2

3

4}, Hongjie Su^{1

2

5

3}, Yi Ding^{1

2}, Lihuan He^{2

6}, Kaibing Liu^{1

2}, Jun Hou^{1

2

5

3}, Kaixiang Pan^{1

2

7}, Liexun He², Sijie Yang^{1

2

5

3}, Lisha Li², Shenghui Yang^{1

2

5

3}, Xiao Peng^{1

2}, Jinming Zhao^{1

2

5

3}, Jack Guan⁸, Xiaocong Kuang^{2

7

3}, Qikai Hua^{1

2

5

3}

Affiliations

¹ Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China.
² Guangxi Diabetic Foot Salvage Engineering Research Center, Guangxi Medical University, Nanning, Guangxi, 530021, China.
³ Research Centre for Regenerative Medicine, Guangxi Medical University, China.
⁴ Department of Orthopedics, The Second Hospital, Jilin University, Changchun, Jilin, 130042, China.
⁵ Collaborative Innovation Centre of Regenerative Medicine and Medical Bio-Resource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China.
⁶ Department of Orthopedics, Sinopharm Dongfeng General Hospital of Hubei University of Medicine, Shiyan, 442000, Hubei, China.
⁷ Yulin Campus of Guangxi Medical University, Yulin, Guangxi, 537406, China.
⁸ Bay Area Foot and Ankle Medical Clinic, San Jose, 3150, California, USA.

Abstract

Background: Tibial Cortex Transverse Transport (TTT) has been demonstrated to be an effective treatment for unilateral diabetic foot ulcers (UDFUs). However, this retrospective study was designed to compare the efficacy and safety of unilateral TTT on bilateral diabetic foot ulcers (BDFUs).

Methods: This retrospective study included a review of patients with TTT treated from January 2017 to August 2019, Propensity Score Matching (PSM) was performed to compare patients with BDFUs to those with UDFUs. Ulcer healing, recurrence, and major amputation rates were evaluated at 1-year follow-up. Changes in foot vessels were assessed in the BDFUs group using computed tomography angiography (CTA).

Results: A total of 140 patients with DFUs (106 UDFUs and 34 BDFUs) were included in the study. UDFUs and BDFUs were matched in a 1:1 ratio (34 in each group) using PSM. No significant difference was observed at 1-year-follow-up [91.2% (31/34) vs. 76.5% (26/34), OR 0.315 (95% CI 0.08 to 1.31), P = 0.10] and 6-month-follow-up [70.6% (24/34) vs. 50.0% (17/34), OR 0.85 (95% CI 0.15 to 1.13), P = 0.08] in two groups. Significant differences in rates of major amputation and recurrence between the groups (P > 0.05) were not observed. The BDFUs group appeared more angiogenesis of the foot by CTA after 8 weeks of operation.

Conclusion: Results of this study suggest that severe BDFUs can be effectively treated by unilateral TTT. TTT is easy to operate and effective, which may be a good alternative for treating severe BDFUs.

The translational potential of this article: In previous retrospective clinical studies, TTT has demonstrated promising clinical outcomes in the management of diabetic foot ulcers. In this current study, we aim to investigate the potential use of TTT in treating distant tissue defects by evaluating the limited availability and safety of TTT for the management of bilateral diabetic foot. While additional basic and clinical research is necessary to fully elucidate the underlying mechanisms, our study offers insight into the potential therapeutic use of TTT for this condition.

Keywords: Angiogenesis; Bilateral diabetic foot ulcers; Tibial cortex transverse transport; Ulcer healing.