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Yang AA, Park N, Gazes MI, Samchukov M, Frumberg DB. Transverse tibial bone transport for non-healing heel wound: A case report. Int J Surg Case Rep 2024; 124:110400. [PMID: 39369454 DOI: 10.1016/j.ijscr.2024.110400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 09/30/2024] [Indexed: 10/08/2024] Open
Abstract
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.
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Affiliation(s)
- Ally A Yang
- Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Nancy Park
- Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Michael I Gazes
- Yale-New Haven Hospital Department of Podiatric Surgery, New Haven, CT, USA
| | - Mikhail Samchukov
- Center for Excellence in Limb Lengthening and Reconstruction, Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - David B Frumberg
- Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT, USA.
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Hao L, Rong K, Chen C, Hou Z, Wang Y, Tian X, Wang Z. Transverse Distraction of Great Toe to Enlarge the Donor Site before Finger Reconstruction. Orthop Surg 2024. [PMID: 39234803 DOI: 10.1111/os.14229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024] Open
Abstract
Partial great toe transfer is widely used in finger reconstruction. Although satisfactory results have been reported at the recipient's hand, the donor foot still presents with many problems due to the large amount of tissues harvested. In this study, the Ilizarov technique was utilized to enlarge the great toe in order to minimize the amount of tissue sacrificed of the donor foot. In this retrospective study, 23 patients (30 toes) underwent transverse distraction of the great toe for finger reconstruction from September 2020 to December 2022. The width of the contralateral normal finger was set as the objective width gained of distraction. At the last follow-up, the changes of bone, toenail, plantar skin, vessel, and nerve of the great toe were measured, and postoperative complications were assessed. The time for active distraction was 46.1 ± 8.3 days, with a widening rate of 0.41 ± 0.08 mm/day. Counting in the time for latency and consolidation, the time of treatment with external fixation was 84 ± 11.9 days. At the last follow-up, the average width of the distal phalanx of the great toe increased from 13.1 to 28.1 mm (p < 0.001). The width of the toenail increased from 15.8 to 30.3 mm (p < 0.001), and the width of the plantar pulp increased from 25.6 to 38.8 mm (p < 0.001). Computed tomography angiography (CTA) and Doppler ultrasound confirmed that the digital arteries and nerves of the great toe were intact after distraction surgery. Two patients needed revision surgery due to complications of pin loosening or premature consolidation. With the help of the Ilizarov technique, the great toe is effectively enlarged after transverse distraction. Multiple tissues of the great toe, including bone, nail, and plantar skin, are regenerated, and more tissues were preserved after toe-to-hand transfer. To the best of our knowledge, this is a novel method to enlarge the donor site for finger reconstruction.
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Affiliation(s)
- Liwen Hao
- Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Hand & Foot Surgery and Reconstructive Microsurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Kai Rong
- Department of Hand & Foot Surgery and Reconstructive Microsurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chao Chen
- Department of Hand & Foot Surgery and Reconstructive Microsurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhidian Hou
- Department of Hand & Foot Surgery and Reconstructive Microsurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yaxing Wang
- Department of Hand and Foot Surgery, Fourth People's Hospital of Jinan, Jinan, China
| | - Xu Tian
- Shandong First Medical University, Jinan, China
| | - Zengtao Wang
- Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Hand & Foot Surgery and Reconstructive Microsurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Zhu Y, Pan S, Xu Y, Shi J, Shi Z. The Efficacy of Modified Ilizarov Distraction-Tension Device on Limb Wound Difficult to Cover with Skin Flaps. Orthop Surg 2024. [PMID: 39223103 DOI: 10.1111/os.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Closure of complex limb wounds poses challenges and requires innovative approaches. This research aimed to evaluate the effectiveness of a modified distraction-tension device using Ilizarov external fixation for wound closure in challenging cases. METHODS A retrospective analysis was conducted on 43 patients with extremity wounds that were difficult to cover with skin flaps between January 2019 and December 2022. Tension-relieving traction was applied using the Ilizarovexternal fixator apparatus, tailored to individual wound characteristics. Three types of wire-pin connections were used in this study. The distraction begins on the third postoperative day, with a speed of 0.5mm/d. Clinical wound healing scores were evaluated at 5 and 30 days postoperatively. Complications were documented following the Paley classification system. RESULTS Traction using modified Ilizarovexternal fixation promoted a significant reduction in wound size. The mean traction period was 11.2 ± 7.3 days, and the mean healing duration was 17.0 ± 3.7 days. The clinical wound healing score improved from 3.7 ± 2.9 at 5 days to 1.7 ± 0.7 at 30 days postoperatively (p < 0.05). Complications were minimal, with no significant obstacles or sequelae observed. Direct closure healing was achieved in 21 cases, skin graft healing in 13 cases, and suture healing in 9 cases. No recurrences were reported. Using Paley's classified complications, there were 17 problems, 9 obstacles, and 0 sequelae. CONCLUSION The Ilizarov tension-relieving traction shows promise in facilitating wound closure that is challenging to manage with skin flaps. The modified three types of pin-skin connection configuration could satisfy various types of wound closure.
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Affiliation(s)
- Yueliang Zhu
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sunwen Pan
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongqing Xu
- 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China
| | - Jian Shi
- 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China
| | - Zhen Shi
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wen Y, Chen L, Lan J, Li L. Efficacy of tibial cortex transverse transport in treating diabetic foot ulcer and its effect on serum omentin-1 and irisin levels. Diabetol Metab Syndr 2024; 16:154. [PMID: 38982536 PMCID: PMC11232319 DOI: 10.1186/s13098-024-01400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE Diabetic foot ulcer (DFU) is a common and debilitating complication of diabetes that is associated with an increased risk of lower-limb amputation and a reduced life expectancy. Tibial cortex transverse transport (TTT) has become a newly alternative surgical method to facilitate ulcer healing and prevent lower limb amputation. Herein, we investigated the efficacy of TTT in treating DFU and changes of serum omentin-1 and irisin levels. METHODS This study prospectively recruited 52 consecutive patients with DFU who were treated with TTT. The follow-up was performed weekly during the first 12 weeks postoperatively and every 3 months until 1 year after TTT. The serum levels of vascular endothelial growth factor (VEGF), omentin-1, and irisin in DFU patients undergoing TTT were determined by ELISA methods on the preoperative 1st day, postoperative 2nd week and 4th week. RESULTS The wound healing rate was 92.3% (48/52) at the 1-year follow-up. The visual analog scale (VAS) pain scores of patients showed a significant reduction at the 4th week after TTT (p < 0.001). The dorsal foot skin temperature, ankle brachial index, and dorsal foot blood flow of patients were significantly increased at the 4th week after TTT (p < 0.001). Results of ELISA methods showed the serum levels of VEGF, omentin-1, and irisin on the 2nd week and 4th week after TTT were notably elevated compared to the levels determined on the preoperative 1st day (p < 0.001). The serum levels of VEGF, omentin-1, and irisin on the 4th week after TTT were also significantly higher than the levels determined on the 2nd week after TTT (p < 0.001). CONCLUSION TTT could promote the wound healing and reduce the risk of lower limb amputation, demonstrating promising clinical benefits in the treatment of DFU. Increased expressions of serum proangiogenic factors including VEGF, omentin-1, and irisin were noted in the early stage after TTT, which may provide a new mechanism of TTT promoting wound heal.
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Affiliation(s)
- Yang Wen
- Orthopedic Center, Orthopaedic Trauma, Suining Central Hospital, No. 27 Dongping North Road, Hedong New District, Suining, 629000, Sichuan, China
| | - Liyuan Chen
- Medical Department, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Jiaping Lan
- Orthopedic Center, Orthopaedic Trauma, Suining Central Hospital, No. 27 Dongping North Road, Hedong New District, Suining, 629000, Sichuan, China
| | - Lei Li
- Orthopedic Center, Orthopaedic Trauma, Suining Central Hospital, No. 27 Dongping North Road, Hedong New District, Suining, 629000, Sichuan, China.
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Kong L, Li Y, Deng Z, Chen X, Xia Y, Shen B, Ning R, Zhang L, Yin Z. Tibial cortex transverse transport regulates Orai1/STIM1-mediated NO release and improve the migration and proliferation of vessels via increasing osteopontin expression. J Orthop Translat 2024; 45:107-119. [PMID: 38524870 PMCID: PMC10960091 DOI: 10.1016/j.jot.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Background Diabetic foot is a major complication of diabetes. The bone transverse transport method could be applied in clinics for treatment, which could improve the metabolism of the tissues via lasting distraction forces. However, the process' specific regulating mechanism is still unknown. Methods Based on the notion that the healing of bones involves the recruitment of calcium ions, in this study, we established the model of tibial cortex transverse transport (TTT) on rats and then used tissue immunologic detection, such as the double fluorescent staining to explore the expression of the calcium channels' calcium release-activated calcium modulator 1 (Orai1)/stromal interaction molecule 1 (STIM1), which belong to the store-operated calcium entry (SOCE) signaling pathways on the tissues around the bone transport area. By using the laser capture microdissection (LCM) tool, we acquired samples of tissues around the bone and endeavored to identify pivotal protein molecules. Subsequently, we validated the functions of key protein molecules through in vitro and in vivo experiments. Results After protein profile analysis, we found the differentially expressed key protein osteopontin (OPN). The in vitro experiments verified that, being stimulated by OPN, the migration, proliferation, and angiogenesis of human umbilical vein endothelial cells (HUVEC) were observed to be enhanced. The activation of Orai1/STIM1 might increase the activity of endothelial nitric oxide synthase (eNOS) and its effect on releasing nitric oxide (NO). Subsequently, the migration and proliferation of the HUVECs are improved, which ultimately accelerates wound healing. These signaling pathway was also observed in the OPN-stimulated healing process of the skin wound surface of diabetic mice. Conclusion This study identifies the molecular biological mechanism of OPN-benefited the migration and proliferation of the HUVECs and provides ideas for searching for new therapeutic targets for drugs that repair diabetes-induced wounds to replace invasive treatment methods. The translational potential of this article The OPN is highly expressed in the tissues surrounding the TTT bone transfer area, which may possibly stimulate the activation of eNOS to increase NO release through the SOCE pathway mediated by Orai1/STIM1. This mechanism may play a significant role in the angiogenesis of diabetic foot's wounds promoted by TTT, providing new therapeutic strategies for the non-surgical treatment for this disease.
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Affiliation(s)
- Lingchao Kong
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Yangyang Li
- School of Basic Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, PR China
| | - Zhongfang Deng
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, PR China
| | - Xiaoyu Chen
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, PR China
| | - Yin Xia
- Department of Anesthesiology, Anhui Provincial Children's Hospital, Hefei, Anhui, PR China
| | - Bing Shen
- Dr. Neher's Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, PR China
| | - Rende Ning
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Lesha Zhang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, PR China
| | - Zongsheng Yin
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
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Liu H, Qian H, Liu J, Zhang D. Meta-analysis on the efficacy of Traditional Chinese Medicine in enhancing surgical site wound healing post-colorectal surgery. Int Wound J 2024; 21:e14444. [PMID: 37953697 PMCID: PMC10949938 DOI: 10.1111/iwj.14444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
This meta-analysis aimed to evaluate the efficacy of Traditional Chinese Medicine (TCM) in enhancing surgical site wound healing following colorectal surgery. We systematically reviewed and analysed randomized controlled trials (RCTs) that investigated the outcomes of TCM interventions in postoperative wound management, adhering to the PRISMA guidelines. The primary outcome was the assessment of wound healing through the REEDA (redness, oedema, ecchymosis, discharge and approximation) scale at two different time points: the 10th day and 1-month post-surgery. Seven RCTs involving 1884 patients were included. The meta-analysis revealed a statistically significant improvement in wound healing in the TCM-treated groups compared to the control groups at both time intervals. On the 10th day post-surgery, the TCM groups exhibited a significant reduction in REEDA scale scores (I2 = 98%; random: SMD: -2.25, 95% CI: -3.52 to -0.98, p < 0.01). A similar trend was observed 1-month post-surgery, with the TCM groups showing a substantial decrease in REEDA scale scores (I2 = 98%; random: SMD: -3.39, 95% CI: -4.77 to -2.01, p < 0.01). Despite the promising results, the majority of the included studies were of suboptimal quality, indicating a need for further high-quality RCTs to substantiate the findings. The results suggest that TCM interventions can potentially enhance wound healing post-colorectal surgery, paving the way for further research in this area to validate the efficacy of TCM in postoperative management.
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Affiliation(s)
- Han‐song Liu
- The First Clinical Medical SchoolNanjing University of Chinese MedicineNanjingChina
| | - Haihua Qian
- Department of AnorectalThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Jiali Liu
- Nanjing University of Chinese MedicineNanjingChina
| | - Dan Zhang
- Department of AnorectalThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
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Liu J, Yao X, Xu Z, Wu Y, Pei F, Zhang L, Li M, Shi M, Du X, Zhao H. Modified tibial cortex transverse transport for diabetic foot ulcers with Wagner grade ≥ II: a study of 98 patients. Front Endocrinol (Lausanne) 2024; 15:1334414. [PMID: 38318295 PMCID: PMC10841573 DOI: 10.3389/fendo.2024.1334414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Background Diabetic foot ulcers constitute a substantial healthcare burden on a global scale and present challenges in achieving healing. Our objective was to assess the efficacy of modified tibial cortex transverse transport surgery in managing refractory diabetic foot ulcers. Methods We retrospectively analyzed clinical data from 98 patients suffering from diabetic foot ulcers classified as Wagner grade ≥II who were admitted to our medical facility between January 2020 and June 2022. All the patients were treated by modified tibial cortex transverse transport surgery, wherein the osteotomy scope was reduced to two rectangular bone windows measuring 1.5cm × 1.5cm each. Record the patient's general information and ulcer healing time; ulcer area, ankle-brachial index, WIFi classification, and visual analogue scale before and 3 months following the surgical intervention. Results The average duration of diabetes of 98 patients with diabetic foot ulcer was 20.22 ± 8.02 years, 52 patients had more than one toe gangrene on admission. The postoperative wound healing rate was 95.83% and the average healing time was 53.18 ± 20.18 days. The patients showed significant improvement in ankle-brachial index, WIFi classification, and visual analogue scale at 3 months postoperatively compared to preoperatively, with statistically significant differences (P< 0.05). Eight patients experienced complications, and the incidence of complications was 8.16%. Throughout the follow-up period, there were no instances of ulcer recurrence noted. Conclusion Modified tibial cortex transverse transport surgery demonstrates effectiveness in the management of diabetic foot ulcers by enhancing lower limb microcirculation and facilitating the process of wound healing.
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Affiliation(s)
- Junpeng Liu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xingchen Yao
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ziyu Xu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yue Wu
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fuchun Pei
- Department of Orthopaedic Surgery, Beijing Chaoyang Integrative Medicine Rescue and First Aid Hospital, Beijing, China
| | - Lin Zhang
- Department of Orthopaedic Surgery, Beijing Chaoyang Integrative Medicine Rescue and First Aid Hospital, Beijing, China
| | - Meng Li
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ming Shi
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinru Du
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hui Zhao
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Ding X, Yuan Y, Xu H, Jing Z, Lu H, Wang Y, Zhou J. Analysis of Risk Factors for in-hospital Death in Elderly Patients with TEXAS Stage 3 and 4 Diabetic Foot Ulcers after Tibial Transverse Translation: A Case-Control Study. Orthop Surg 2023; 15:3272-3278. [PMID: 37814800 PMCID: PMC10694016 DOI: 10.1111/os.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE Chinese physicians developed the Tibial Transverse Transport (TTT) technique to treat diabetic foot ulcers with more than 90% effective rate. But this method still could not avoid the in-hospital death of patients. This study adopted a case-control study to explore the risk factors of in-hospital death in elderly patients with chronic ischemic diabetic foot after receiving TTT treatment. METHODS A total of 54 patients were included in the study from January 1, 2017 to April 30, 2021, by being paired with the cases in case group with their demographic data and results of blood routine, liver and kidney function. There were nine patients in case group with six male and three male. Forty-five patients were selected in control group according to gender and diabetes type with 30 male and 15 female. Single factor logics regression analysis was used to explore the risk factors and odd ratios (OR) of in-hospital death in patients. The nomogram and decision curve analysis (DCA) had been done by R Studio software. RESULTS The study found that age, course of diabetic foot, small dense low-density Lipoprotein (smLDL), homocysteine (Hcy), superoxide dismutase (SOD), and prealbumin (PA) were risk factors for in-hospital death of patients. The smLDL had the highest risk. The nomogram showed that PA accounted for the largest proportion in the death risk factors. The results of DCA proved that above six risk factors were the risk factors for patients with TEXAS Stage 3 and 4 diabetic foot ulcers. CONCLUSION In the future diagnosis and TTT treatment for diabetic foot ulcers, doctors need to pay close attention to age, course of diabetic foot, smLDL, Hcy, SOD, and PA.
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Affiliation(s)
- Xiaofang Ding
- Department of Orthopaedics, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
- Beijing Longfu HospitalBeijingChina
| | - Yusong Yuan
- Department of Orthopaedic SurgeryChina‐Japan Friendship HospitalBeijingChina
| | - Hailin Xu
- Department of Trauma and Orthopaedics, Peking University People's HospitalPeking UniversityBeijingChina
- National Center for Trauma medicineBeijingChina
- Diabetic Foot Treatment Centre, Peking University People's HospitalPeking UniversityBeijingChina
| | - Zhengwei Jing
- Department of Health Policy and Management, School of Public HealthPeking UniversityBeijingChina
| | - Hao Lu
- Department of Trauma and Orthopaedics, Peking University People's HospitalPeking UniversityBeijingChina
- National Center for Trauma medicineBeijingChina
- Diabetic Foot Treatment Centre, Peking University People's HospitalPeking UniversityBeijingChina
| | | | - Junlin Zhou
- Department of Orthopaedics, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
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Ou S, Wu X, Yang Y, Xia C, Zhang W, Qu Y, Li J, Chen B, Zhu L, Xu C, Qi Y. Tibial cortex transverse transport potentiates diabetic wound healing via activation of SDF-1/CXCR4 signaling. PeerJ 2023; 11:e15894. [PMID: 37727693 PMCID: PMC10506586 DOI: 10.7717/peerj.15894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 09/21/2023] Open
Abstract
Background The current treatments for diabetic foot ulcers have disadvantages of slow action and numerous complications. Tibial cortex transverse transport (TTT) surgery is an extension of the Ilizarov technique used to treat diabetic foot ulcers, and can shorten the repair time of diabetic foot ulcers. This study assessed the TTT technique for its effectiveness in healing diabetic foot ulcer skin lesions and its related molecular mechanisms. Methods Diabetic rat models were established by injecting healthy Sprague-Dawley rats with streptozotocin (STZ). The effects of TTT surgery on the model rats were assessed by recording changes in body weight, analyzing skin wound pictures, and performing H&E staining to assess the recovery of wounded skin. The numbers of endothelial progenitor cells (EPCs) in peripheral blood were analyzed by flow cytometry, and levels of CXCR4 and SDF-1 expression were qualitatively analyzed by immunofluorescence, immunohistochemistry, qRT-PCR, and western blotting. Results Both the histological results and foot wound pictures indicated that TTT promoted diabetic wound healing. Flow cytometry results showed that TTT increased the numbers of EPCs in peripheral blood as determined by CD34 and CD133 expression. In addition, activation of the SDF-1/CXCR4 signaling pathway and an accumulation of EPCs were observed in skin ulcers sites after TTT surgery. Finally, the levels of SDF-1 and CXCR4 mRNA and protein expression in the TTT group were higher than those in a blank or fixator group. Conclusion TTT promoted skin wound healing in diabetic foot ulcers possibly by activating the SDF-1/CXCR4 signaling pathway.
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Affiliation(s)
- Shuanji Ou
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Xiaodong Wu
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Yang Yang
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Changliang Xia
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Wei Zhang
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Yudun Qu
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Jiaxuan Li
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Bo Chen
- Department of Endocrinology, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Lilin Zhu
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Changpeng Xu
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Yong Qi
- Department of Orthopaedics, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
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Chen K, Yu Y, Shu J, Zhang B, Wang G, Wu B. Efficacy of tibial transverse transport combined with platelet-rich plasma versus platelet-rich plasma alone in the treatment of diabetic foot ulcers: A meta-analysis. CHINESE JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY 2023; 5:145-153. [DOI: 10.1016/j.cjprs.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
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Wen R, Cheng X, Cao H, Zhang L, Luo F, Shang W. Transverse Tibial Bone Transfer in the Treatment of Diabetes Foot Ulcer: A Pilot Study. Diabetes Metab Syndr Obes 2023; 16:2005-2012. [PMID: 37427081 PMCID: PMC10328219 DOI: 10.2147/dmso.s413884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background The treatment of diabetes-related foot complications is a clinical challenge. The underlying complicating factors of peripheral vascular disease render most diabetic foot ulcers asymptomatic until the ulcer fails to heal and becomes clinically distinct, constituting a significant cause of disability and even death in diabetic patients. Objective To evaluate the clinical efficacy of tibial transverse transport (TTT) in the treatment of patients with diabetic foot ulcers. Methods A total of 35 patients who met the inclusion criteria were selected as the study group from patients with diabetic foot ulcers diagnosed and treated at our hospital between August 2019 and March 2021 and were treated with TTT, and 35 patients who also met the inclusion criteria were included in the routine group and were given conventional wound debridement. The primary endpoint of this study was clinical efficacy, including pain condition, trauma condition, ankle-brachial index, and peripheral nerve recovery. Results Patients receiving TTT showed significantly reduced visual analogue scale (VAS) scores than those with conventional treatment (P<0.05). TTT resulted in a significant reduction of trabecular area and better trabecular healing versus conventional treatment (P<0.05). TTT was associated with significantly higher ankle-brachial index (ABI) and lower Michigan neuropathy screening instrument (MNSI) scores in patients versus conventional debridement (P<0.05). Conclusion TTT effectively alleviates the pain of diabetic foot ulcer patients, promotes wound healing, and improves ankle-brachial index and peripheral nerve recovery. In the context of the high amputation rate of diabetic foot ulcers treated by internal medicine, TTT contributes positively to the enhancement of patient prognosis and merits clinical promotion.
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Affiliation(s)
- Rongzhi Wen
- Department of Orthopaedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, People’s Republic of China
| | - Xinhua Cheng
- Department of Orthopaedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, People’s Republic of China
| | - Hong Cao
- Department of Orthopaedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, People’s Republic of China
| | - Lei Zhang
- Department of Orthopaedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, People’s Republic of China
| | - Fangcheng Luo
- Department of Orthopaedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, People’s Republic of China
| | - Wei Shang
- Department of Orthopaedics, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, People’s Republic of China
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12
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Hu XX, Xiu ZZ, Li GC, Zhang JY, Shu LJ, Chen Z, Li H, Zou QF, Zhou Q. Effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 13:1095361. [PMID: 36686461 PMCID: PMC9846025 DOI: 10.3389/fendo.2022.1095361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
Background Diabetic foot ulcerations (DFUs) are a common but highly morbid complication of long-standing diabetes, carrying high rates of associated major amputation and mortality. Transverse tibial bone transport (TTT) has recently been applied for treatment of DFUs with the aim of accelerating wound healing. This study was performed to evaluate the effectiveness and safety of TTT in patients with DFUs. Methods Two authors independently retrieved the platforms of PubMed, Embase and CENTRAL, to identify studies associated with treatment of DFUs with TTT. Quantitative meta-analyses were performed to pool all available outcomes about the effectiveness and complications of TTT operation, with fixed- (I2<50%) or random-effect (I2>50%) model according to I2. Results A total of 7 studies, involving 818 participants, were included, with 661 participants treated with TTT operation. The pooled healing rate and limb salvage rate were 0.96 (95%CI: 0.93~0.98) and 0.98 (95%CI: 0.95~1.00) respectively after treatment with TTT. The pooled mean healing time was 15.03 (95%CI: 9.05~21.00) months. When compared with the pre-operative baseline values, the ankle-brachial index (ABI, MD: 0.23; 95%CI: 0.03~0.44; p<0.001), skin temperature (MD: 1.56; 95%CI: 0.30~2.81; p<0.001), and visual analogue scale (VAS, MD: 3.70; 95%CI: 1.97~5.44; p<0.001) were significantly improved at the final follow-up. When compared with non-TTT group, the TTT group was associated with higher healing rate (OR: 10.43; 95%CI: 3.96~27.43; p<0.001) and limb salvage rate (OR: 9.65; 95%CI: 3.30~28.20; p<0.001). Concerning the complications of the TTT process, the pooled risks of fracture at transportation site and pin-site infection were 0.02 (95%CI: 0.00~0.04) and 0.08 (95%CI: 0.00~0.22), respectively; and the DFU recurrence rate in TTT group was significantly lowered comparing to that of the non-TTT group (RR: 0.18; 95%CI: 0.06~0.49; p=0.001). Conclusions TTT operation was associated with high healing rate and limb salvage rate, and could significantly improve the ABI, skin temperature, and VAS after operation. When compared with the control group, TTT group provided significantly higher healing rate and limb salvage rate. However, TTT operation should be conducted with caution concerning the incidences of fracture at tibia, infection at pin channels and necrosis of skin overlying the anterior tibia.
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Affiliation(s)
- Xing-xi Hu
- Department of Orthopedics and Trauma, The Affiliated Hospital of Yunnan University (The Second People’s Hospital of Yunnan Province, The Eye Hospital of Yunnan Province), Kunming, Yunnan, China
| | - Zheng-zhong Xiu
- Department of Orthopedics, The First People’s Hospital of Dali City, Dali, China
| | - Gui-chun Li
- Department of Orthopedics, The First People’s Hospital of Dali City, Dali, China
| | - Ji-yuan Zhang
- Department of Orthopedics, The First People’s Hospital of Dali City, Dali, China
| | - Long-jun Shu
- Department of Orthopedics, The First People’s Hospital of Dali City, Dali, China
| | - Zhong Chen
- Department of Orthopedics and Trauma, The Affiliated Hospital of Yunnan University (The Second People’s Hospital of Yunnan Province, The Eye Hospital of Yunnan Province), Kunming, Yunnan, China
| | - Han Li
- Western Yunnan University of Applied Science and Technology, Dali, China
| | - Qing-feng Zou
- Department of Orthopedics, The First People’s Hospital of Dali City, Dali, China
| | - Quan Zhou
- Department of Orthopedics, The First People’s Hospital of Dali City, Dali, China
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13
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Qi Y, Xu C, Wu X, Ou S. Thromboangiitis obliterans successfully treated with radius transverse transport. Asian J Surg 2022; 45:2808-2809. [PMID: 35753919 DOI: 10.1016/j.asjsur.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Yong Qi
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Changpeng Xu
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Xiaodong Wu
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Shuanji Ou
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China.
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14
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Li J, Wang W, Yang H, Li B, Liu L. Management of Elderly Traumatic Ankle Arthritis with Ilizarov External Fixation. Orthop Surg 2022; 14:2447-2454. [PMID: 36001696 PMCID: PMC9531104 DOI: 10.1111/os.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/05/2022] [Accepted: 06/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis. Methods From June 2013 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution. Conventional double‐feet standing X‐ray films were taken before and after operation. The tibiotalar angle on X‐ray image was measured to evaluate the degree of talipes varus and valgus. The Foot and Ankle pain score of American Orthopaedics Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) were compared by using paired t‐test to evaluate the functional recovery. Results All of the patients acquired effective postoperative 18–49 months follow‐up, with an average of 31.5 months. All patients were included in the analysis, among which 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). All ankles achieved bony fusion; the clinical healing time was 12.7 weeks on average (11–18 weeks). The AOFAS score was 45.36 ± 6.43 preoperatively and 80.25 ± 9.16 at 12 months post‐operation, with a statistically significant difference (p < 0.0001). The VAS score was 8.56 ± 1.85 on average preoperatively and 2.72 ± 0.83 at 12 months post‐operation, with a statistically significant difference (p < 0.0001). The tibiotalar angle was 101.93° ± 4.12° preoperatively and 94.45° ± 2.37° at 12 months post‐operation, with a statistically significant difference (p < 0.0001). The results of the functional evaluation indicated that 44 patients (61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results. Conclusion Our study demonstrated that it is possible to obtain satisfactory outcome with Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
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Affiliation(s)
- Jun Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Wenzhao Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Yang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bohua Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Zhao L, Lei Y, Pang M, Wei Z. An improved bone transport surgical method for treating chronic ischemic ulcers (thromboangiitis obliterans). Front Surg 2022; 9:859201. [PMID: 36061060 PMCID: PMC9437542 DOI: 10.3389/fsurg.2022.859201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction The chronic ischemic injury of the upper/lower limbs caused by thromboangiitis obliterans (TAO, Buerger's disease) is difficult to heal, leading to high morbidity and amputation risk, seriously lowering the quality of life of patients. So far, the pathogenesis of this disease is still not clear, and there are still no effective therapeutic approaches. Here, we first use an improved bone transport technique to treat TAO-related foot ulcers and achieve good therapeutic effects. Materials and Methods In this report, 22 patients met the inclusion criteria, and we provide an improved bone transport technique to repair TAO-related chronic lower limb wounds, which have a minimally surgical incision and a satisfying surgical field. Results The improved bone transport technique resulted in TAO-related chronic lower extremity wound healing in most patients (18, M:F 16:2) within the first treatment cycle. All wounds healed completely after two treatment cycles. After these cycles, the cold sensation in the patients' feet was significantly relieved, and the rest pain in the lower extremities was significantly relieved (Visual Analog Scale, P < 0.0001). Furthermore, the Laser Doppler flowmeter showed that the blood perfusion and percutaneous oxygen pressure of the affected foot were higher than in preoperation (P < 0.0001). To conclude, bone transport technology is available for the refractory wounds of the extremity, which may promote healing by increasing blood circulation and tissue oxygen supply. Conclusions In summary, the improved surgical method of the bone transport technique is worth considering in the treatment of thromboangiitis obliterans-related foot ulcers.
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Affiliation(s)
- Liang Zhao
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | - Yu Lei
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Mengru Pang
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zairong Wei
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Zunyi Medical College, Zunyi, China
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