Management of severe diabetic foot using modified transverse bone transport: A retrospective study of Wagner grade 3 to 4 cases

This study evaluates the effectiveness of a modified transverse tibial bone transport technique (combining bone and periosteum transfer) in treating Wagner grade 3 to 4 diabetic foot. This retrospective study included patients diagnosed with Wagner grade 3 to 4 diabetic foot, with a minimum follow-up duration of 6 months. Key selection criteria included adequate lower limb vascularity confirmed by CT angiography (CTA) and no major systemic contraindications. The study assessed foot and limb preservation rates, ulcer healing time, complications, foot skin temperature, resting pain (visual analog scale (VAS) score), and CTA changes before and after surgery. The mean follow-up was 11.43 ± 3.75 months. Significant improvements were observed in key outcomes: foot temperature increased from 33.43 ± 0.87°C preoperatively to 36.02 ± 0.88°C at 8 weeks post-op ( P < .001), and VAS pain scores decreased from 4.87 ± 1.02 preoperatively to 2.87 ± 0.77 at 8 weeks post-op ( P < .001). Ulcers healed in 93.75% of cases, with a mean healing time of 8.46 ± 1.79 weeks. The overall complication rate was 10.42%, and 79.17% of patients showed improved vascularization. Modified transverse tibial bone transport may support microvascular regeneration, improve foot temperature, alleviate pain, and promote ulcer healing, demonstrating favorable clinical outcomes and a low incidence of complications in patients with severe diabetic foot. Given the retrospective nature of this study and the absence of a control group, further research with prospective controlled designs is necessary to confirm these findings.