Transverse Tibial Bone Transfer (Ttbt) in Diabetic Foot Ulcer (Dfu): Technical Aspects, Biochemical Mechanisms, Safety and Outcomes of a Novel Surgical Method

Background. Diabetic foot ulcers (DFUs) affect a substantial proportion of the 589 million adults currently living with diabetes worldwide and remain a leading cause of lower-limb amputation and excess mortality. Despite debridement, offloading, advanced dressings, negative-pressure wound therapy, hyperbaric oxygen, topical growth factors, and revascularisation, recalcitrant ulcers still progress to amputation in approximately 20% of cases, with five-year mortality near 70% among those amputated. Tibial cortex transverse transport (TTT), a derivative of Ilizarov’s distraction osteogenesis principle, has emerged as a regenerative surgical option for advanced DFUs. Methods. We performed a narrative review of literature published between January 2001 and April 2026, identified through PubMed and Google Scholar, addressing surgical technique, biological mechanisms, clinical efficacy, and safety of TTT in DFU. Results. TTT, a small antero-medial tibial corticotomy with slow transverse distraction, elicits a coordinated regenerative response. Mechanistic studies show distraction-induced elevation of proangiogenic mediators and satisfactory outcomes in patients. Clinical data, including a meta-analysis, a multicentre cohort and other small studies, indicate wound healing rates of approximately 95%, limb salvage rates exceeding 95%, and recurrence rates near 3% during two-year follow-up. Significant improvements in ankle-brachial index, dorsal foot temperature, pain scores, and quality of life are consistently reported. Complications are manageable: risks of approximately 2% for tibial fracture and 8% for pin-site infection. Conclusions. TTT is a mechanistically rich, clinically effective, and reasonably safe option for advanced DFUs. Adequately powered multicentre randomised trials comparing TTT with contemporary best practice are needed to define its definitive role.