Treatment of diabetic foot with the transverse tibial bone transport guided by three-dimensional printing guide plates

Transverse tibial bone transport for non-healing heel wound: A case report

INTRODUCTION

Treatment of diabetic foot ulcer is complex and expensive, and frequently results in amputation. Transverse Tibia Transport is a new strategy for diabetic foot ulcers, which is based on the techniques of distraction histogenesis.

PRESENTATION OF CASE

We present a 32-year-old male with longstanding insulin-dependent diabetes mellitus and many medical comorbidities with a non-healing heel ulcer of greater than 1 year. Following diagnosis of his diabetic foot ulcer complicated by osteomyelitis, he underwent a series of vascular and local wound interventions unsuccessfully. Transverse tibia transport was successful in healing the ulcer after 4 months. No complications were observed during follow up.

DISCUSSION

Distraction histogenesis mechanically stimulates regeneration of soft tissues such as muscles, tendons, and blood vessels by sustained tension. Inducing vascular regeneration at a targeted site has broad potential value for treating various disorders such as atrophic union and osteomyelitis.

CONCLUSION

For patients with refractory diabetic foot ulcers, transverse tibia transport may be considered as a treatment option.

Clinical applications and prospects of 3D printing guide templates in orthopaedics

Background

With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics.

Methods

In this paper, a systematic review of the orthopedic guide template is presented, where the history of 3D-printing-guided technology, the process of guides, and basic clinical applications of orthopedic guide templates are described. Finally, the limitations of the template and possible future directions are discussed.

Results

The technology of 3D printing surgical templates is increasingly mature, standard, and intelligent. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, and choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure in various types of surgeries. It simplifies the difficult surgical steps and accelerates the growth of young and mid-career physicians. But some problems such as cost, materials, and equipment limit its development.

Conclusions

In different fields of orthopedics, the use of guide templates can significantly improve surgical accuracy, shorten the surgical time, and reduce intraoperative bleeding and radiation. With the development of 3D printing, the guide template will be standardized and simplified from design to production and use. 3D printing guides will be further sublimated in the application of orthopedics and better serve the patients.

The translational potential of this paper

Precision, intelligence, and individuation are the future development direction of orthopedics. It is more and more popular as the price of printers falls and materials are developed. In addition, the technology of meta-universe, digital twin, and artificial intelligence have made revolutionary effects on template guides. We aim to summarize recent developments and applications of 3D printing guide templates for engineers and surgeons to develop more accurate and efficient templates.