Published online Dec 15, 2023. doi: 10.4239/wjd.v14.i12.1784
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
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.
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.
To evaluate the early hemodynamic changes in patients with non-arterial stenosis and arterial stenosis diabetic foot treated by TTT.
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.
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.
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.
TTT may achieve tissue regeneration of the affected limb through some mechanism, and this regeneration may be comprehensive, involving vascular, nerve, and skin regeneration.