Chinese Association of Orthopaedic Surgeons (CAOS) clinical guideline for the treatment of diabetic foot ulcers using tibial cortex transverse transport technique (version 2020)

Summary: Ilizarov discovered the phenomenon of rich vascular network formation during distraction osteogenesis for limb regeneration and functional reconstruction. The tension-stress rule could activate and enhance the regenerative potentials of living tissues, leading to growth or regeneration of muscles, fascia, blood vessels, and nerves simultaneously. Orthopaedic surgeons in China applied the tibial cortex transverse transport (TTT) technique to reconstruct limb microcirculation, to treat lower extremity microvascular lesions and diabetic foot ulcers since 2001. Clinical studies from China demonstrated that the TTT technique could effectively regenerate the microvascular network in the lower limbs of diabetic patients, promote ulcer healing and reduce the amputation rate. As a novel treatment for severe Diabetic Foot Ulcers (DFU), the TTT technique may be adopted in different countries to benefit DFU patients worldwide. This guideline is initiated by the Chinese Association of Orthopaedic Surgeons (CAOS) TTT Technique for Diabetes Foot Taskforce Group. This guideline provides clear recommendations for indications, contraindications, principles for surgical procedures, preoperative and postoperative management, which maximize the success rate for TTT surgery in treatment of severe DFU. The translational potential of this article: This guideline provides clear recommendations for indications, contraindications, principles for surgical procedures, preoperative and postoperative management, which maximize the success rate for TTT surgery in severe DFU treatment. This guideline serves as a starting reference for those who are interested or about to carry out TTT surgery. As an alternative novel treatment for severe DFU, we hope that the TTT technique may be adopted in different countries soon to benefit DFU patients worldwide.