Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers

Nie, Xinyu; Kuang, Xiaocong; Liu, Guangwei; Zhong, Zhaowei; Ding, Yi; Jie, Yu; Liu, Jie; Li, Shanlang; He, Liexun; Su, Hongjie; Qin, Wencong; Zhao, Jinmin; Hua, Qikai; Chen, Yan

doi:10.1016/j.jot.2020.11.001

Cited by 21 publications

(21 citation statements)

References 34 publications

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“…In a recent study, Chen and colleagues successfully employed optimized proximal TCTD to treat severe and recalcitrant diabetic foot ulcers in 136 patients and achieved ulcer healing in 96% of the patients 16 . The effective role of TCTD has been also demonstrated in recalcitrant non‐diabetic leg ulcers 19 . The potential mechanisms of TCTD are considered as follows, inducing neovascularization and consequently increasing blood perfusion, improving tissue healing, promoting anti‐infection and so on 19 .…”

Section: Discussionmentioning

confidence: 99%

“…The effective role of TCTD has been also demonstrated in recalcitrant non‐diabetic leg ulcers 19 . The potential mechanisms of TCTD are considered as follows, inducing neovascularization and consequently increasing blood perfusion, improving tissue healing, promoting anti‐infection and so on 19 . Based on the outstanding work in these previous studies, we proposed that TCTD could also promote the complete healing of chronic ulcers in the patients with foot and ankle deformity with ulcers.…”

Section: Discussionmentioning

confidence: 99%

“…In the previous study reported by Nie et al . 19 , the Texas wound classification system was also successfully used for evaluation the non‐diabetic ulcers. The National Pressure Ulcer Advisory Panel (NPUAP) classification is one of the most widely recognized systems for categorizing pressure ulcers 8 .…”

Section: Methodsmentioning

confidence: 99%

“…In this system, grading is done based on depth of the lesion, and stages are classified on presence of ischemia, wound bioburden or combination of both excluding neuropathy. In the previous study reported by Nie et al 19 , the Texas wound classification system was also successfully used for evaluation the non-diabetic ulcers. The National Pressure Ulcer Advisory Panel (NPUAP) classification is one of the most widely recognized systems for categorizing pressure ulcers 8 .…”

Section: Ulcers Classificationmentioning

confidence: 99%

“…Tibial cortex transverse distraction (TCTD), a novel technique based on the “tension‐stress principle” proposed by Ilizarov 14 , 15 , has been shown as an effective treatment for chronic ulcers resulting from diabetes mellitus, thromboangiitis obliterans, and chronic ischemic diseases 16 , 17 , 18 . It also has been demonstrated that TCTD has the advantages of facilitating the healing of recalcitrant non‐diabetic ulcers and shortening the healing time compared with conventional surgical methods 19 . The oretically, based on the potential mechanisms (promote angiogenesis, control infection, and improve wound healing) of TCTD, this technique could also be used for the management of foot and ankle deformities with concurrent ulcers which share common characteristics with diabetic or ischemic ulcers: chronic inflammation and impaired microcirculation.…”

Section: Introductionmentioning

confidence: 99%

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Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers

Chen

et al. 2021

Orthopaedic Surgery

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Objective: To assess the feasibility and results of tibial cortex transverse distraction (TCTD) followed by open correction with internal fixation (OCIF) for foot and ankle deformity with concurrent ulcers.Methods: A retrospective analysis was conducted. Between 2010 and 2019, a two-stage management of TCTD followed by OCIF was performed in 13 patients (13 feet). There were five males and eight females with a mean age of 33.8 AE 14.6 years. Ten patients had a right-side lesion, and three patients had a left-side lesion. The etiology of deformity included seven cases of congenital neurological disease, one case of Charcot-Marie-Tooth disease, one case of trauma sequelae, and three cases of myelomeningocele. Duration of disease, size of ulcers, surgical procedures, healing time, external fixation time, and complications of these patients were recorded. The Texas wound classification and National Pressure Ulcer Advisory Panel (NPUAP) classification were used for assessing the ulcers. The modified Dimeglio score of deformity and American Orthopeadic Foot and Ankle Society (AOFAS) ankle-hindfoot score were applied to evaluate the status before treatment and the results at final follow-up. Results:The TCTD and wound debridement were performed in all patients, and an additional Ilizarov correction technique was added in two patients. All ulcers were healed in 3 months after first-stage treatment. The median patient self-report time of ulcer healing was 2.0 weeks (IQR, 1.8-3.3). The median external fixation time was 138.0 days (IQR, 134.5-141.5) days. After second-stage operative correction, the patients were followed-up for an average of 28.0 AE 2.9 months. At the final follow-up, the modified Dimeglio score of deformity was decreased from 6.7 AE 2.1 to 1 (IQR, 0.0-1.0), and the mean AOFAS score was improved from 42.9 AE 19.1 to 82.6 AE 7.7. Before the treatment, there were eight patients with severe deformity, four patients with moderate deformity, and one patient with mild deformity. Postoperatively, seven patients were classified as mild deformity and six patients had a postural foot. The results of AOFAS ankle-hindfoot score were defined as excellent in three patients, as good in five, and as fair in five. Complications include one case of mild displacement of the osteotomized cortex and one case of pin-tract infection. No delayed union, nonunion, relapse of ulcers, or deformity were observed. Conclusions:The two-stage management of TCTD followed by OCIF could be considered as an alternative treatment for foot and ankle deformities combined with chronic ulcers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%