Impact of tibial transverse transport in tissue regeneration and wound healing with perspective on diabetic foot ulcers

In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatment for patients with diabetic foot ulcers(DFU).TTT has been associated with tissue regeneration,improved blood circulation,reduced amputation rates,and increased expression of early angiogenic factors.Mechanistically,TTT can influence macrophage polarization and growth factor upregulation.Despite this potential,the limitations and conflicting results of existing studies justify the need for further research into its optimal application and development.These clinical implications highlight the efficacy of TTT in recalcitrant DFU and provide lasting stimuli for tissue re-generation,and blood vessel and bone marrow improvement.Immunomodu-lation via systemic responses contributes to its therapeutic potential.Future studies should investigate the underlying molecular mechanisms to enhance our understanding and the efficacy of TTT.This manuscript emphasizes the potential of TTT in limb preservation and diabetic wound healing and suggests avenues for preventive measures against limb amputation in diabetes and peripheral artery disease.Here,we highlight the clinical significance of the TTT and its importance in healing DFU to promote the use of this technique in tissue regeneration.

Early hemodynamics after tibial transverse transport in patients with nonarterial stenosis and arterial stenosis diabetic foot

BACKGROUND The diagnosis of peripheral arteriopathy in the diabetic foot is complicated by diabetes and its advanced complications.It has been found that diabetic foot can be categorized into arterial stenosis and non-arterial stenosis,both of which have significant differences in hemodynamic characteristics.AIM To evaluate the early hemodynamic changes in diabetic foot patients with nonarterial stenosis and arterial stenosis treated by tibial transverse transport(TTT)using high-frequency color Doppler ultrasonography(HFCDU)and a laser Doppler flowmeter.METHODS Twenty-five patients with Wagner grades 3-5 diabetic foot ulcers were treated with TTT,and the wound healing time and rate were recorded.Patients were grouped according to the results of preoperative lower-extremity ultrasonography.Cases with≥50%stenosis in any of the femoral,popliteal,posterior tibial,anterior tibial,and peroneal arteries of the affected limb were classified as the arterial stenosis group(n=16);otherwise,they were classified as the nonarterial stenosis group(n=9).Before and one month after surgery,HFCDU was used to evaluate the degree of lower limb artery lesions and hemodynamic changes in patients.The degree of femoral-popliteal atherosclerotic stenosis,the degree of vascular stenosis and occlusion of the lower-knee outflow tract,and the degree of medial arterial calcification were scored;the three scores were added together to obtain the total score of lower extremity arteriopathy.PeriScanPIM3,a laser Doppler flowmeter system,was used to detect alterations in plantar microcirculation before and 1 mo after surgery.Wound healing and hemodynamic indices were compared between the two groups.RESULTS The wound healing time of the diabetic foot was significantly shorter in the nonarterial stenosis group than in the arterial stenosis group(47.8±13 vs 85.8±26,P<0.05),and the wound healing rate of both groups was 100%.The preoperative total lower extremity arteriopathy scores were lower in the nonarterial stenosis group than those in the arterial stenosis group(18.89±8.87 vs 24.63±3.52,P<0.05).The nonarterial stenosis group showed higher preoperative popliteal artery(POA)blood flow than the arterial stenosis group(204.89±80.76 cc/min vs 76.75±48.49 cc/min,P<0.05).Compared with the baseline(before surgery),the postoperative POA blood flow of the affected limb in the nonarterial stenosis group decreased one month after surgery(134.11±47.84 cc/min vs 204.89±80.76 cc/min,P<0.05),while that in the arterial stenosis group increased(98.44±30.73 cc/min vs 61.69±21.70 cc/min,P<0.05).Although the POA blood flow in the arterial stenosis group was obviously improved one month after surgery,it was still lower than that in the nonarterial stenosis group(98.44±30.73 cc/min vs 134.11±47.84 cc/min,P<0.05).The nonarterial stenosis group had higher preoperative plantar microcirculation than the arterial stenosis group(56.1±9.2 vs 33.2±7.5,P<0.05);compared with the baseline,the plantar microcirculation in the arterial stenosis group was significantly improved one month after surgery(51.9±7.2,P<0.05),while that in the nonarterial stenosis group was reduced(35.9±7.2,P<0.05).CONCLUSION Based on preoperative HFCDU findings,diabetic foot patients can be divided into two categories:Those with nonarterial stenosis and those with arterial stenosis,with obvious differences in hemodynamic changes in the early postoperative period between them.In the early stage after TTT,the blood flow volume and velocity and the plantar microcirculation perfusion of the affected limb of the diabetic foot with nonarterial stenosis decreased compared with the baseline,while those of the diabetic foot with arterial stenosis improved significantly compared with the baseline,although both had smoothly healed diabetic foot ulcers.

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

Background:Diabetic foot ulcers(DBFU)are one of the main complications of diabetes.Platelet-rich plasma(PRP)treatment is a commonly used treatment option.Tibial transverse transport(TTT)also has a therapeutic effect on DBFU.Some studies have found that the TTT combined with PRP(TTT&PRP)has a significant effect on DBFU.Methods:PubMed,Cochrane Library,Web of Science,EMBASE,Chinese Biomedical Literature,CNKI,VIP,and Wanfang databases were used to find literature on the treatment of DBFUs using the TTT and PRP treatment according to the inclusion criteria.The specific inclusion criteria are as follows:(1)research type:clinical controlled trials,including retrospective cohort and randomized controlled studies;(2)diagnosis of DBFUs that does not include a definitively diagnosed traumatic ulcer;(3)original materials of Chinese and English literature published in full text.The exclusion criteria are:(1)the research group was not defined or grouped;(2)nonrandomized controlled trials,non-cohort studies,non-case-control studies,retrospective studies,and case reports;(3)repetitive research and animal experimentation;(4)ulcers caused by other diseases;(5)conservative treatment or no use of invasive treatment methods.Review Manager software(version 5.3)was used to conduct a meta-analysis of the included results.Result:The literature included 6 randomized controlled studies,including 508 patients,254 patients in the PRP treatment group,and 254 patients in the TTT&PRP group.The meta-analysis results showed that in terms of treatment efficacy,the TTT&PRP combined treatment group had a higher efficacy than the PRP group.After treatment,the TTT&PRP group had better treatment effects in psychological function,physiological function,and social function compared to the PRP group.After treatment,the TTT&PRP group showed a significant increase in serum epidermal growth factor(EGF),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and platelet-derived growth factor(PDGF)levels compared to the PRP group.In terms of wound healing after treatment,the TTT&PRP group performed better than the PRP group in terms of postoperative wound reduction rate,bacterial clearance rate,granulation tissue coverage rate,and granulation tissue growth thickness.Conclusion:TTT combined with PRP was more effective than PRP alone in treating DBFUs.