School of Podiatric Medicine - Student Research
Beyond Revascularization: Is Tibial Transverse Transport the Next Frontier in Diabetic Limb Salvage?
Document Type
Poster
Publication Date
9-26-2026
Abstract
Poster Category: Non-sponsored.
Level of Evidence: Level III
Introduction: Diabetic foot ulceration remains a major cause of lower-extremity amputation despite multidisciplinary wound care, debridement, infection control, offloading, and revascularization. Tibial transverse transport (TTT), based on the Ilizarov tension-stress principle, uses controlled transverse distraction of tibial cortex to promote angiogenesis and distal microcirculation in severe or recalcitrant diabetic foot ulcers (DFUs).
Aim: To systematically evaluate whether TTT improves wound healing, distal perfusion, ulcer recurrence, and limb salvage in severe or recalcitrant DFUs and define its potential role as an adjunctive salvage intervention.
Methods: A PRISMA-guided review of peer-reviewed literature through August 2026 was conducted using PubMed/MEDLINE and reference screening. Eight relevant articles were identified; five were selected for primary synthesis based on clinical relevance, study quality, sample size, comparative design, and reported healing, perfusion, recurrence, or amputation outcomes.
Results: TTT was consistently associated with improved healing, limb preservation, and distal perfusion. A comparative cohort (n=273) demonstrated higher 2-year healing (96% vs 68%; P< 0.001), lower major amputation (2.9% vs 23%; P< 0.001), and lower recurrence (2.9% vs 17%; P< 0.001). A prospective multicenter cohort (n=1,072) reported 94.9% healing, 4.9% major amputation, and 3.1% recurrence, with blood flow increasing from 8.1±2.2 to 28.3±3.9 mL/100 g/min (P=0.003). Meta-analysis (7 studies; n=818) demonstrated 96% pooled healing and 98% limb salvage. A 2026 comparative cohort (n=138) found improved postoperative ABI (P< 0.001) and fewer unplanned reoperations (P=0.003), although major-amputation-free survival was not significantly different (P=0.625).
Conclusions: TTT is a promising perfusion-directed adjunct for carefully selected severe or recalcitrant DFUs, demonstrating high healing and limb-salvage rates with improved distal perfusion. However, predominantly nonrandomized evidence limits definitive conclusions. TTT should complement, not replace, revascularization, infection control, debridement, offloading, and multidisciplinary care, with multicenter randomized trials needed to define indications and comparative effectiveness.
Recommended Citation
Sebastian, Karishma A. and John, Nidhin, "Beyond Revascularization: Is Tibial Transverse Transport the Next Frontier in Diabetic Limb Salvage?" (2026). School of Podiatric Medicine - Student Research. 58.
https://scholarworks.utrgv.edu/sopm_mspub/58
