Efficacy and safety of unilateral tibial cortex transverse transport on bilateral diabetic foot ulcers: A propensity score matching study

Qin, Wencong; Nie, Xinyu; Su, Hongjie; Ding, Yi; He, Lihuan; Liu, Kaibing; Hou, Jun; Pan, Kaixiang; He, Liexun; Yang, Sijie; Li, Lisha; Yang, Shenghui; Peng, Xiao; Zhao, Jinming; Guan, Jack; Kuang, Xiaocong; Hua, Qikai

doi:10.1016/j.jot.2023.08.002

Cited by 6 publications

(3 citation statements)

References 37 publications

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“…In these works, the diabetic rat model with induced hindlimb ischemia presented marked neovascularization accompanying with upregulation of angiogenic factors, such as SDF-1 and CXCR4. VEGF is a well-recognized angiogenic factor, which was demonstrated to be increased in the serum sample of patients with DFU at the 4th week after TTT in our study, concurring with other studies [ 35 , 36 ]. Most importantly, TTT has demonstrated its proangiogenic effects related to upregulation of omentin-1 and irisin in our study.…”

Section: Discussionsupporting

confidence: 93%

Efficacy of tibial cortex transverse transport in treating diabetic foot ulcer and its effect on serum omentin-1 and irisin levels

Wen,

Chen,

Lan

et al. 2024

Diabetol Metab Syndr

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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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Section: Discussionsupporting

confidence: 93%

Efficacy of tibial cortex transverse transport in treating diabetic foot ulcer and its effect on serum omentin-1 and irisin levels

Wen,

Chen,

Lan

et al. 2024

Diabetol Metab Syndr

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“…This angiogenic response is thought to be mediated by the activity of endothelial progenitor cells (EPCs) and signaling molecules such as Hypoxia-inducible factor-1α (HIF-1α) and stromal cell-derived factor-1 (SDF-1), as indicated by studies on angiogenesis induced by distraction osteogenesis (DO) [ 9 – 11 ]. In our retrospective clinical study, we observed that TTT can elevate the expression levels of SDF-1 and HIF-1α in patients' peripheral blood, which is consistent with previous research findings [ 8 ]. Moreover, TTT is proposed to enhance the healing process by modifying the immune environment, as demonstrated by Yang et al who reported that TTT induces a shift from M1 to M2 macrophage phenotypes, thus improving local immunity in patients [ 12 ].…”

Section: Introductionsupporting

confidence: 92%

“…Previous investigations have corroborated that TTT not only augments healing rates in DFUs but also diminishes the rates of amputation and ulcer recurrence, concurrently improving postoperative revascularization of the lower extremities and enhancing foot microcirculation [ 5 – 7 ]. Additionally, our research has revealed that unilateral TTT can facilitate the healing of bilateral DFUs, offering new insights into the treatment of multifocal DFUs [ 8 ]. Despite these promising clinical outcomes, the mechanisms underlying TTT's therapeutic impact warrant further exploration.…”

Section: Introductionmentioning

confidence: 99%

Tibial cortex transverse transport promotes ischemic diabetic foot ulcer healing via enhanced angiogenesis and inflammation modulation in a novel rat model

Qin,

Liu,

et al. 2024

Eur J Med Res

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Background Tibial Cortex Transverse Transport (TTT) represents an innovative surgical method for treating lower extremity diabetic foot ulcers (DFUs), yet its underlying mechanisms remain elusive. Establishing an animal model that closely mirrors clinical scenarios is both critical and novel for elucidating the mechanisms of TTT. Methods We established a diabetic rat model with induced hindlimb ischemia to mimic the clinical manifestation of DFUs. TTT was applied using an external fixator for regulated bone movement. Treatment efficacy was evaluated through wound healing assessments, histological analyses, and immunohistochemical techniques to elucidate biological processes. Results The TTT group demonstrated expedited wound healing, improved skin tissue regeneration, and diminished inflammation relative to controls. Marked neovascularization and upregulation of angiogenic factors were observed, with the HIF-1α/SDF-1/CXCR4 pathway and an increase in EPCs being pivotal in these processes. A transition toward anti-inflammatory M2 macrophages indicated TTT's immunomodulatory capacity. Conclusion Our innovative rat model effectively demonstrates the therapeutic potential of TTT in treating DFUs. We identified TTT's roles in promoting angiogenesis and modulating the immune system. This paves the way for further in-depth research and potential clinical applications to improve DFU management strategies.

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“Innovation and translation of biological and biomaterial treatment for challenging musculoskeletal disorders”

Qin

2023

Journal of Orthopaedic Translation

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Efficacy and safety of unilateral tibial cortex transverse transport on bilateral diabetic foot ulcers: A propensity score matching study

Cited by 6 publications

References 37 publications

Efficacy of tibial cortex transverse transport in treating diabetic foot ulcer and its effect on serum omentin-1 and irisin levels

Efficacy of tibial cortex transverse transport in treating diabetic foot ulcer and its effect on serum omentin-1 and irisin levels

Tibial cortex transverse transport promotes ischemic diabetic foot ulcer healing via enhanced angiogenesis and inflammation modulation in a novel rat model

“Innovation and translation of biological and biomaterial treatment for challenging musculoskeletal disorders”

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