The study aimed to introduce anterior superior iliac spine distraction to treat severe and recalcitrant diabetic foot ulcers. For comparison, we also included another group of diabetic foot ulcers treated with proximal tibial cortex transverse distraction.
From February 1998 to February 2020, 87 patients (87 feet) with severe and recalcitrant diabetic foot ulcers were treated. The mean age of patients at surgery was 64 years (range, 47 to 87 years). The severity of the narrowed artery was assessed using the ankle-brachial index test. For comparison, another group of 91 patients (91 diabetic foot ulcers) treated with proximal tibial cortex transverse distraction was included.
The mean preoperative ankle-brachial indexes of the two groups were 0.41±0.07 and 0.39±0.05 (OR 0.65 [95% CI -0.77 to 1.58]; P=0.62), respectively. The mean preoperative limb pain was 3.42±2.84 cm and 3.52±3.11 cm (OR 1.54 [95% CI -077 to 1.35]; P=0.083), respectively. At the 2-year follow-up visit, ulcers healed in 72 (83%) and 74 (81%) patients, respectively (P=0.188). The mean postoperative limb pain was 0.52±0.23 cm and 0.49±0.41 cm (OR 2.32 [95% CI -0.27 to 1.66]; P=0.078), respectively. Pin-site infection occurred in 2 patients and 8 patients (P=0.09), respectively. Ulcer recurrence occurred in 13 (15%) patients and 15 (16%) patients (P=0.205), respectively.
Anterior superior iliac spine transverse distraction may be an effective alternative treatment for severe and recalcitrant diabetic foot ulcers. It may be associated with fewer distraction-site complications than proximal tibial cortex transverse distraction.
Level of evidence
Therapeutic study, Level IIa.
Abbreviations:ASISD (anterior superior iliac spine distraction), PTCTD (Proximal tibial cortex transverse distraction), DFU (Diabetic foot ulcer)
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- The diabetic foot ulcer.Aust J Gen Pract. 2020; 49: 250-255
- Prevention, assessment, diagnosis and management of diabetic foot based on clinical practice guidelines: a systematic review.Medicine. 2019; 98 (Baltimore): e16877
- The efficacy of a polyhydrated ionogen impregnated dressing in the treatment of recalcitrant diabetic foot ulcers: a multi-centre pilot study.Acta Chir Belg. 2007; 107: 675-681
- Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation.Int Wound J. 2017; 14: 537-545
- Updating the diabetic foot treatment algorithm: recommendations on treatment using advanced medicine and therapies.Wounds. 2018; 30: 29-35
- Tibial cortex transverse transport accelerates wound healing via enhanced angiogenesis and immunomodulation.Bone Joint Res. 2022; 11: 189-199
- Application of transverse tibial bone transport and microcirculation reconstruction in the treatment of diabetic foot ulcer: a case report.Ann Palliat Med. 2021; 10: 8358-8364
- Tibial cortex transverse distraction in treating diabetic foot ulcers: what are we concerned about?.J Int Med Res. 2020; 48 (300060520954697)
- Proximal tibial cortex transverse distraction facilitating healing and limb salvage in severe and recalcitrant diabetic foot ulcers.Clin Orthop Relat Res. 2020; 478: 836-851
- CORR Insights®: proximal tibial cortex transverse distraction facilitating healing and limb salvage in severe and recalcitrant diabetic foot ulcers.Clin Orthop Relat Res. 2020; 478: 852-853
- International working group on the diabetic F. Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review.Diabetes Metab Res Rev. 2016; 32 (Suppl): 136-144
- Pain in diabetic foot ulcers.Ostomy Wound Manag. 2003; 49 (Suppl): 24-29
- Guidelines for noninvasive vascular laboratory testing: a report from the American society of echocardiography and the Society of vascular medicine and biology.J Am Soc Echocardiogr. 2006; 19: 955-972
- Non-invasive vascular assessment in the foot with diabetes: sensitivity and specificity of the ankle brachial index, toe brachial index and continuous wave Doppler for detecting peripheral arterial disease.J Diabetes Complicat. 2016; 30: 155-160
- Plantar pressures in diabetic patients with foot ulcers which have remained healed.Diabet Med. 2009; 26: 1141-1146
- Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer.Wound Repair Regen. 2017; 25 (Apr): 309-315
- Impairment characteristics of static balance and plantar load distribution of patients undergoing tibial cortex transverse distraction for diabetic foot ulcers.J Orthop Surg Res. 2022; 17: 171
- Tibial cortex transverse transport facilitating healing in patients with recalcitrant non-diabetic leg ulcers.J Orthop Translat. 2020; 27: 1-7
- Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.Injury. 2011; 42 (Suppl): S3-15
Published online: December 01, 2022
Accepted: November 26, 2022
Received in revised form: November 21, 2022
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