Abstract
Objective: To explore the clinical effect of tibial transverse transport (TTT) technique combined with continuous low negative pressure wound therapy in the treatment of Wagner grade Ⅲ to Ⅴ chronic diabetic foot ulcers. Methods: This study was a retrospective cohort study. From January 2016 to December 2022, 38 patients with Wagner grade Ⅲ to Ⅴ chronic diabetic foot ulcers who met the inclusion criteria were admitted to the Department of Orthopedics of West China Hospital of Sichuan University. According to the treatment method for the ulcer wounds, the patients were divided into a control group (20 cases, 10 males and 10 females, aged (64.0±2.3) years) treated with TTT technique alone and a combined treatment group (18 cases, 10 males and 8 females, aged (60.8±2.9) years) treated with TTT technique combined with continuous low negative pressure wound therapy. After debridement, the ulcer wound areas in control group and combined treatment group were (29±13) cm² and (30±18) cm², respectively. Postoperatively, ulcer wound healing and the occurrence of complications were observed. The incidence of complications, ulcer wound healing time, external fixator removal time, time to ambulation, and time to full weight-bearing of the affected limb in the two groups of patients were statistically analyzed and compared. Before surgery and at the last follow-up, the ankle-brachial index or differences in ankle-brachial index, skin temperature, and visual analogue scale (VAS) score of the affected foot were statistically analyzed and compared between the two groups of patients. The ulcer wound healing time was the primary observation indicator, and the other indicators were secondary observation indicators. Results: Postoperatively, in combined treatment group, one patient developed a new ulcer at another site after the original ulcer wound healed; this ulcer wound healed after the patient was re-admitted for treatment with TTT technique combined with continuous low negative pressure wound therapy. One patient had a recurrence of the ulcer at the same site due to poor blood glucose control and underwent amputation. The ulcer wounds of the other patients healed well. In control group, four patients had recurrence of the ulcer wound due to poor blood glucose control, among whom one patient underwent amputation and three patients healed after treatment with TTT technique combined with continuous low negative pressure wound therapy. The incidence of complications in combined treatment group and control group of patients were 2/18 and 4/20, respectively, showing no statistically significant difference between the two groups (P>0.05). Postoperatively, compared with those in control group, the ulcer wound healing time, external fixator removal time, time to ambulation, and time to full weight-bearing of the affected limb in combined treatment group of patients were significantly shortened (with Z values of 2.52 and 4.90, respectively, and t values of 3.99 and 4.10, respectively, P<0.05). The difference in ulcer wound healing time between the two groups of patients was 6 (1, 11) days. Before surgery, there were no statistically significant differences in the VAS score, ankle-brachial index, and skin temperature of the affected foot between the two groups of patients (P>0.05). At the last follow-up, compared with those in control group, the VAS score of the affected foot in combined treatment group of patients was significantly decreased (Z=2.24, P<0.05), the differences in ankle-brachial index was significantly increased (t=3.53, P<0.05) and the skin temperature was significantly increased (Z=4.49, P<0.05). Conclusions: The TTT technique combined with continuous low negative pressure wound therapy can significantly shorten the ulcer wound healing time, external fixator removal time, time to ambulation, and time to full weight-bearing of the affected limb in the treatment of Wagner grade Ⅲ to Ⅴ chronic diabetic foot ulcers, and effectively improve the ankle-brachial index, skin temperature, and pain of the affected foot, showing good clinical application prospects and safety.