Transverse Tibial Bone Transport (TTT): Advanced Limb Salvage for Non-Healing Wounds

Transverse tibial bone transport (TTT), also called tibial cortex transverse transport, is an innovative surgical technique that can save limbs when traditional wound care has failed. It is primarily used for patients with chronic non-healing diabetic foot ulcers, severe wounds, or poor circulation that puts them at risk for amputation.

We use the latest research and techniques to offer this advanced option to patients in Naples, Fort Lauderdale, and Miami who need limb salvage care.

What Is Transverse Tibial Bone Transport?

TTT is based on the Ilizarov principle of distraction osteogenesis—a proven method where controlled bone movement stimulates the body's natural healing response.

In this procedure:

1. A small section of the tibia (shin bone) is carefully cut and moved slowly across the bone using an external fixator device.

2. This controlled movement triggers the body to grow new blood vessels (neovascularization), improve microcirculation, and promote tissue regeneration in the foot and ankle.

3. The result: chronic wounds that wouldn't heal with standard care often close completely, and limb amputation can be avoided.

Who Is a Candidate for TTT?

This procedure is typically considered for patients with:

• Diabetic foot ulcers (Wagner grade II or higher) that have not healed despite optimal wound care

• Chronic non-healing wounds on the foot or ankle

• Poor circulation (peripheral arterial disease) where revascularization has failed or is not possible

• Osteomyelitis (bone infection) in combination with a non-healing wound

• Patients facing amputation as the only remaining option

What Does the Research Show?

The newest studies (2024-2025) demonstrate impressive outcomes:

Study Highlights:

• 95.83% complete wound healing in diabetic foot ulcer patients (average healing time: 53 days)

• Improved blood flow measured by ankle-brachial index (ABI)

• Significant pain reduction (VAS scores)

• 95% limb salvage rate in a 120-patient study over 8 years

• 100% limb salvage in a recent case series of patients with severe dysvascular foot wounds

What to Expect: The Procedure and Recovery

Before Surgery:

• Comprehensive evaluation including vascular studies, wound assessment, and imaging

• Optimization of blood sugar control and nutrition

• Discussion of realistic goals and timeline

The Procedure:

• Performed under anesthesia

• A small bone window is created in the tibia

• An external fixator device is applied to control bone movement

• The procedure is designed to preserve tibial stability and minimize fracture risk

After Surgery:

• The bone segment is moved gradually (usually 1 mm/day for about 2 weeks)

• Regular follow-up visits to monitor wound healing and adjust the device

• Pin site care to prevent infection

• Most patients see significant wound improvement within 4-8 weeks

• The external fixator is typically removed once the wound has healed and the bone has consolidated

Risks and Complications

As with any surgery, TTT carries risks. The most common complications reported in recent studies include:

• Pin site infections (manageable with antibiotics and pin care)

• Bone segment necrosis (rare, ~8% in high-risk patients)

• Venous thrombosis (blood clots, ~6%)

• Device-related discomfort

Your surgical team will carefully screen for risk factors and monitor you closely throughout the process.

HERES SOME OTHER WAYS WE USE THIS TECHNIQUE OF DISTRACTION OSTEOGENESIS IN THE LEGS