Transverse Tibial Bone Transport: Another Brick in the Wall for the Treatment of Recalcitrant Diabetic Foot Ulcers—A Pilot Study

Background/Objectives: Recalcitrant diabetic foot ulcers represent a major clinical challenge and are associated with a high risk of limb loss, particularly in patients with advanced ischemia and neuropathy. Improvement of local perfusion is a key prerequisite for wound healing. Transverse bone transport (TBT), based on the Ilizarov tension–stress principle, has been shown to enhance microcirculation but remains largely unfamiliar in Western healthcare systems. This pilot study aimed to evaluate the feasibility, safety, and preliminary clinical outcomes of transverse tibial bone transport (TTBT) in patients with severe diabetic foot syndrome. Methods: This prospective, single-center, single-arm pilot study included ten consecutive patients with advanced diabetic foot ulcers who were referred for major amputation. All patients underwent TTBT using a unilateral external fixator according to a standardized distraction protocol. Ulcer severity was classified using the IWGDF–PEDIS system. Clinical outcomes, complications, operative time, and wound healing were assessed over a follow-up period of 6 months. Results: The cohort comprised seven men and three women with a mean age of 63.8 years. Seven patients had type II diabetes mellitus and three had type I diabetes mellitus. Perfusion was graded as PEDIS 3 in nine patients and PEDIS 1 in one patient; all patients had advanced polyneuropathy. Average ulcer area was 28.5 cm², and patients had undergone a mean of 4.2 prior surgical procedures. Mean operative time was 72 minutes and decreased over the course of the series, reflecting a learning curve. No intraoperative complications occurred. One patient developed a postoperative hematoma requiring revision. Complete wound healing was achieved in eight patients, while two patients showed marked improvement with ongoing healing. Conclusions: This pilot cohort proved TBT as a feasible and safe treatment modality, and demonstrated encouraging preliminary wound healing outcomes in patients with recalcitrant diabetic foot ulcers. TTBT may represent a valuable adjunctive limb-salvage strategy and warrants further investigation in larger controlled studies.