Tibial Cortex Transverse Transport (TTT) is an emerging surgical technique used in the treatment of ischemic foot pathologies, especially in patients with diabetic foot ulcers (DFUs), peripheral artery disease (PAD), and chronic limb-threatening ischemia (CLI). Based upon the Ilizarov’s tension-stress principle, the TTT technique implements a tibial corticotomy followed by a controlled mechanical distraction of the segment with the goal of promoting both localized and systemic angiogenesis. This review collects research from peer-reviewed literature published between January 2020 and July 2025, assessing the clinical efficacy, immunological findings, and the revascularization potential of TTT in limb salvage. Clinical studies consistently demonstrate that TTT enhances wound healing by promoting neovascularization. It was also found that distal perfusion improved in patients when other methods of healing were unsuccessful. Angiographic evidence reveals strong evidence of the formation of new vascular networks. In addition, increasing the Ankle-Brachial Index and observable warming of ischemic limbs were noted, showing improvements in microcirculation. Furthermore, TTT was shown to activate mechanisms responsible for regeneration, with those immunological markers being present during wound healing. While promising results have been expressed through clinical success and high rates of limb salvage, limitations still remain. Challenges such as potential complications, lack of procedural consistency, cytokine response variability, and a low volume of randomized controlled trials suggest the need for more research. Nonetheless, TTT is an alternative therapeutic method for patients with poor revascularization and limited treatment options, displaying a growing body of research supporting its function as a regenerative limb salvage intervention.
Shkolnik et al. (Wed,) studied this question.