Transverse Tibial Transport: Surgical Technique and Insights From First International Case Series

Chronic limb ischemia (CLI) is a significant health issue, particularly among patients with diabetes who are at elevated risk of diabetic foot ulcers (DFU) due to peripheral neuropathy and ischemia. In Singapore, approximately one in six adults is affected by diabetes, with a lifetime risk of developing DFU ranging from 15% to 25%. This paper examines the indications, surgical techniques and postoperative protocols for transverse tibial transport (TTT), an innovative limb salvage procedure implemented in a general hospital in Singapore and presents our early experience with this technique. All six patients in our study successfully achieved limb salvage with complete wound healing, with a median healing time of 4 months. Four patients required additional wound debridement and skin coverage to facilitate healing. Importantly, none of the patients experienced pin site infections during the procedure or throughout the postoperative healing phase. Our study demonstrates favourable outcomes and underscores the clinical utility of TTT in augmenting the multimodal treatment of recalcitrant DFUs.