Abstract
Objective: To investigate the medium- and long-term clinical efficacy of tibial transverse transport (TTT) surgery in the treatment of diabetic foot ulcers (DFU). Methods: This study was a retrospective cohort study. From January 2015 to December 2022, 87 patients with DFU who met the inclusion criteria were admitted to the Department of Orthopedics of Shanxi Provincial People's Hospital. There were 70 males and 17 females, aged (59±11) years. The patients were treated with TTT surgery. At 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively, the number of cases due to amputation, death, or loss to follow-up of patients was 85, 82, 77, 73, and 63, respectively. Data including the ankle brachial index (ABI), number of 10 g monofilament test points, Michigan neuropathy screening instrument (MNSI) physical examination score, visual analogue scale (VAS) score of pain, and toe oxygen saturation of the affected feet were recorded before surgery and at 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years after surgery. The occurrence of complications, such as fractures and infections, wound healing, and amputation were recorded within 3 years after surgery. Results: The levels of ABI of the affected feet were 0.70 (0.65, 0.76), 0.93 (0.83, 1.01), 0.96 (0.86, 1.06), 0.93 (0.88, 1.01), 0.91 (0.86, 0.97), and 0.90 (0.81, 0.97) at 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years after surgery, which were significantly higher than 0.55 (0.47, 0.62) before surgery (P<0.05). At 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years after surgery, the number of 10 g monofilament test points of the affected feet was significantly more than that before surgery (P<0.05), the VAS scores of pain and MNSI physical examination scores of the affected feet were significantly lower than those before surgery (P<0.05), and the levels of toe oxygen saturation of the affected feet were significantly higher than those before surgery (P<0.05). Within 3 years after surgery, 3 patients experienced fractures at the bone transport site, and 4 patients developed infections at the pin tract and incision, all of whom recovered with conservative treatment; the wounds healed in 80 patients, and 7 patients underwent amputation. Conclusions: The TTT surgery applied in treating patients with DFU can significantly improve lower limb blood supply and foot microcirculation, alleviate pain, and enhance nerve conduction function and foot sensation, with few postoperative complications and remarkable results in wound healing and limb salvage, and maintain good overall efficacy within 3 years after surgery.