Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2023; 14(12): 1784-1792
Published online Dec 15, 2023. doi: 10.4239/wjd.v14.i12.1784
Early hemodynamics after tibial transverse transport in patients with nonarterial stenosis and arterial stenosis diabetic foot
Mei-Mei Liao, Sen Chen, Jia-Rui Cao, Meng-Wei Wang, Zhi-Hui Jin, Jia Ye, Yi-Jun Ren, Rui-Qiang Guo
Mei-Mei Liao, Rui-Qiang Guo, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Sen Chen, Jia-Rui Cao, Meng-Wei Wang, Zhi-Hui Jin, Jia Ye, Yi-Jun Ren, Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Co-first authors: Mei-Mei Liao and Sen Chen.
Author contributions: Liao MM and Chen S contributed equally to this work and are co-first authors. Liao MM and Chen S contributed to the research design and thesis writing; Liao MM, Chen S, Cao JR, and Guo RQ collected and analyzed the data; Wang MW, Jin ZH, Ye J, and Ren YJ contributed to the data collection; Liao MM, Chen S, and Guo RQ overall supervise the study; and all authors contributed to the article and approved the submitted version.
Supported by the General Project of Hubei Provincial Department of Health, No. WJ2021M139.
Institutional review board statement: The study was reviewed and approved by the People's Hospital of Wuhan University (Approval No. WDRY2022-K200).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rui-Qiang Guo, PhD, Doctor, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei Province, China. ruiqiangwhrm@hotmail.com
Received: August 8, 2023
Peer-review started: August 8, 2023
First decision: September 19, 2023
Revised: October 18, 2023
Accepted: November 9, 2023
Article in press: November 9, 2023
Published online: December 15, 2023
Processing time: 128 Days and 6.9 Hours
ARTICLE HIGHLIGHTS
Research background

At present, there are many methods to treat diabetic feet, with blood sugar control and local wound management as the treatment principle. For most patients with Wagner grade 1 to 2 diabetic foot ulcers, wound healing can be achieved by controlling blood sugar, dressing change, negative pressure wound therapy, etc. But for Wagner grade 3 and above, the traditional treatment methods are less effective.

Research motivation

During the treatment, we observed that the skin sensation and temperature of the affected foot were obviously improved and the wounds healed smoothly after the tibial transverse transport (TTT) therapy. It was found that the diabetic foot can be divided into arterial stenosis and non-arterial stenosis categories that were significantly different in hemodynamic characteristics.

Research objectives

To evaluate the early hemodynamic changes in patients with non-arterial stenosis and arterial stenosis diabetic foot treated by TTT.

Research methods

Twenty-five patients with Wagner grade 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, classified as arterial stenosis group (n = 16); otherwise, they were classified as non-arterial stenosis group (n = 9). Before and one month after surgery, high-frequency color Doppler ultrasonography (HFCDU) was used to evaluate the degree of lower limb artery lesions and hemodynamic changes of 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. Alterations in plantar microcirculation before and 1 mo after surgery were detected. Wound healing and hemodynamic indexes were compared between the two groups.

Research results

The wound healing time of diabetic foot was significantly shorter in non-arterial stenosis group than in arterial stenosis group, and the wound healing rate of both groups was 100%. Non-arterial stenosis group showed higher preoperative popliteal artery (POA) blood flow than arterial stenosis group. Although the POA blood flow in arterial stenosis group was obviously improved one month after surgery, it was still lower than that in non-arterial stenosis group. Non-arterial stenosis group had higher preoperative plantar microcirculation than arterial stenosis group.

Research conclusions

Patients with diabetic foot can be divided into arterial stenosis and non-arterial stenosis according to the stenosis of femoral POA and three inferior genicular arteries by HFCDU, and the hemodynamic changes in the early postoperative period between the two categories are obviously different.

Research perspectives

TTT may achieve tissue regeneration of the affected limb through some mechanism, and this regeneration may be comprehensive, involving vascular, nerve, and skin regeneration.