Tibial Osteodistraction Angiogenesis for Diabetic Foot Ischemia: A Systematic Review and Meta-Analysis

Diabetes-related lower extremity amputations (LEAs) are a significant global issue, exacerbated by the rising prevalence of diabetes and peripheral artery disease (PAD). Traditional revascularization techniques often fail in patients with severe vascular damage or comorbidities. Tibial Osteodistraction angiogenesis (ODA) represents a novel approach, leveraging angiogenesis to improve perfusion and wound healing. A systematic review was conducted across four databases. Inclusion criteria focused on studies evaluating ODA in diabetic foot ulcers and chronic ischemic wounds. Outcomes analysed included amputation rates, wound healing, mortality, and safety metrics. Eighteen studies (n = 3000 treated with ODA) were included, with subjects aged 35-87. Diabetes prevalence was 87.8%. ODA demonstrated high limb salvage rates (92%-100%) and wound healing rates (58%-100%). Pooled analysis revealed amputation rates of 2% and mortality rates of 4%. Angiogenic cytokine levels increased post-procedure, suggesting enhanced angiogenesis. Complications were minimal, with a 3% pin-site infection rate and 4% major adverse limb events. ODA offers a promising addition for patients with limb-threatening ischemia, achieving significant improvements in perfusion, wound healing, and limb salvage. Despite study heterogeneity and limitations, ODA's angiogenic benefits warrant further research through randomised clinical trials to validate its efficacy and broaden clinical adoption.