Objective: This study investigates the effectiveness of tibia periosteum distraction (TPD) applied to the tibial periosteum, for the treatment of ischemic diabetic foot and vasculitic foot conditions.

Methods: A retrospective analysis was conducted on 33 patients (36 limbs) who underwent TPD between June 2019 and May 2022. Evaluation included capillary refill and wound healing assessment, along with pre- and postoperative analysis of foot skin temperature, ankle-brachial index (ABI), visual analogue scale (VAS) pain scores, and peripheral blood oxygen saturation. CT angiography (CTA) was utilized to assess vascular conditions in both lower limbs.

Results: All 33 patients were successfully followed up for a duration ranging from 4 to 24 weeks (mean: 11.03 weeks). VAS pain scores significantly decreased from preoperative (5.09 ± 1.70, range: 2-8) to postoperative two weeks (2.24 ± 0.90, range: 1-4) (t = 9.44, p < .001). Oxygen saturation levels increased from 83.88% ± 11.82% (range: 58%-97%) preoperatively to 91.36% ± 5.69% (range: 76%-98%) at two weeks postoperatively (t = - 4.21, p < .001). Foot skin temperature also showed a significant increase (t = -3.98, p < .001). Capillary refill test at two weeks postoperatively demonstrated notable improvement. CTA revealed evident neovascularization in the operated limbs compared to preoperative conditions. Wound improvement was significant in all 33 patients within two months postoperatively.

Conclusion: TPD emerges as a promising technique for chronic ischemic lower limb diseases, demonstrating favorable preliminary outcomes in wound healing promotion and amputation rate reduction. Nevertheless, largescale randomized controlled trials are essential to further validate its efficacy. 

Naxin Zeng has completed his Bachelor’s degree at the age of 22 years from XiangYa School of Medicine, USA. He is the head of orthopaedics department of YueYang Centrral Hospital, China. His innovative periosteal distraction surgery has been applied in more than 7,000 clinical cases in China and achieved good results.