Diabetic foot is a serious complication of diabetes. The conditions are complex and serious, and the treatment methods are diverse but the effect is often not ideal. The lower extremity artery lesions of diabetic foot are distributed in stages, and the lower knee artery is more likely to be involved, such as anterior tibial artery, posterior tibial artery, peroneal artery and so on.4,6 These sub-knee arteries have the characteristics of small diameter, hard plaque texture, not easy to fully dilate blood vessels, as well as distance from the heart, small arterial pressure, and poor distal inflow, easy to form thrombus after dilatation, resulting in blood microcirculation disorders.3,4 Tissues lack of adequate nutrition, and ulcers are difficult to heal. The effect of reconstructing blood microcirculation below knee, especially foot, is not accurate, so the clinical application in diabetic foot therapy is limited.
TCTD technology can stimulate the regeneration of peripheral tissue by applying transverse, slow and continuous traction tension to the bone window of tibial cadre.7,8 It promotes the regeneration of bone window and distal microvascular network, improve the ischemia and hypoxia of distal tissue, and fundamentally solve the problems of ischemic necrosis and neuropathy caused by diabetic foot, so as to cure diabetic foot.7,8 In this study, one case underwent amputation because of aggravated infections. There were no cases with complication like tibia fractures. Pin-site infections occur in 2 patients. The infected pin-site healed after dressing changing for 2 weeks. For the other 22 patients, their ulcers healed at postoperative 8.2 ± 4.5 weeks. The VAS reduced significantly when compared with preoperative VAS. Therefore, TCTD combined with debridement and vacuum sealing drainage could produce good clinical effects.
For the treatment of Wagner stage 3/4 diabetic foot, TCTD has some limitations. The external fixation needs to be fixed for nearly 3 months, it affects the daily life of patients to some extent. After fixing the external fixation frame, the common complication is nail infection. Long-term nail care is needed to prevent nail infection and affect the surgical effect. If the direction and rate of the external fixation frame change, it will have adverse consequences, since the treatment requires high compliance. Therefore, we should communicate effectively and fully with the patients and their families before operation, inform the perioperative treatment process and nursing matters needing attention, and prevent the patients from having too high expectations and many reasons leading to the interruption of treatment and the occurrence of surgical complications. In addition, transversal bone movement of the tibia only reconstructs the blood flow of the foot, promotes wound healing, and does not treat diabetes, so there is a possibility of recurrence.
In conclusion, when combined with other measures like debridement and VSD, TCTD can bring advantages for patients diagnosed with diabetic foot ulcers, and the trauma of this operation remains a factor to be considered.