Triplanar Osteotomy Combined with Proximal Tibial Transverse Transport to Accelerate Healing of Recalcitrant Diabetic Foot Ulcers

Abstract Background: Management of recalcitrant diabetic foot ulcers remains challenging. Tibial transverse transport (TTT) has been verified as an effective method for enhancing the healing of foot ulcers. This retrospective study reported a novel triplanar osteotomy in the tibia and assessed the clinical outcomes of TTT for diabetic foot ulcers. Methods: 59 patients with recalcitrant diabetic foot ulcers were divided into the TTT (32 patients) and control (27 patients) groups. In the TTT group, the patients underwent triplanar osteotomy of the proximal tibia, followed by 2 weeks of medial distraction and 2 weeks of lateral distraction. In the control group, the patients received conventional management, including debridement, revascularisation, and reconstruction. Ulcer healing and healing time, amputation, recurrence, and complications were assessed at an 18-month follow-up visit. Computed tomography angiography (CTA) was used to evaluate vessel changes in the lower limbs of patients in the TTT group. Results: The TTT group was superior to the control group in the healing rate (29/32 vs. 18/27) and the healing time (4.6 ± 1.7 months vs. 7.4 ± 2.5 months), respectively. The proportions of amputation and recurrence in the TTT group were lower than that in the control group, without statistical difference. After triplanar osteotomy and transverse distraction, CTA showed more small vessels in the wound area and ipsilateral limb. All patients achieved satisfactory union of the osteotomized bone fragment after removal of the external fixator. Conclusions: Triplanar osteotomy combined with proximal tibial transverse distraction accelerated wound healing and limb salvage caused by severe and recalcitrant diabetic foot ulcers. Triplanar osteotomy can not only increase the bone contact area, which is beneficial for rapid bone reconstruction, but also preserve the vascularisation of the bone fragment and substantially facilitate capillary angiogenesis during distraction. These results suggest that triplanar osteotomy followed by tibial transverse distraction is an effective method for treating diabetic foot ulcers.