Transverse tibial bone transport promotes distraction osteogenesis and improves blood flow in the management of diabetic foot

Figure 1 An elderly female patient with left diabetic foot of Wagner’s grade 2 underwent transverse tibial bone transport of the affected limb + ulcer debridement + vacuum sealing drainage. A: Preoperative wound; B: The vacuum drainage device was removed one week after the operation, and transverse tibial bone transport was initiated; C: Fresh granulation was formed on the wound surface one week after the transport; D: Four weeks after the transport, the wound surface significantly contracted, and the bone transport device was removed; E: The wound healed completely 20 weeks after bone transport. The clinical images have obtained the patient's informed consent and have been anonymized.

Figure 2 An elderly male patient with left diabetic foot (Wagner’s grade 4) underwent transverse tibial bone transport. A: Computed tomography (CT) examination demonstrated a large quantity of new bone in the medullary cavity corresponding to the bone transport block one month after the operation; B: A large quantity of new bone in the medullary cavity 1 month after the operation; C: CT examination showed leg bone morphology; D: There was scarce bone in the corresponding part of the medullary cavity before the operation.

Figure 3 A patient, an elderly male with a left-sided Wagner grade 4 diabetic foot, underwent transverse tibial bone transport. A: Popliteal arterial blood flow before the operation; B: B-ultrasound indicated a marked elevation in popliteal arterial blood flow one month after the operation. A linear array probe (frequency: 5.0-12 MHz) was employed during examination.

Figure 4 An elderly male patient with left Wagner grade 4 diabetic foot received transverse tibial bone transport. A: The number of lower leg collateral vessels and blood flow velocity before the operation; B: B-ultrasound examination using a linear array probe (frequency: 5.0-12 MHz) showed a pronounced rise in both the number of lower leg collateral vessels and blood flow velocity 1 month after the operation.

Figure 5 An elderly male patient with left-sided Wagner’s grade 4 diabetic foot received transverse tibial bone transport. A: Preoperative assessment revealed sparse blood flow signals and poor microcirculation in the plantar skin; B: One month post-surgery, the plantar blood flow signals were abundant and the microcirculation was significantly improved.