In this multicentre retrospective cohort, tibial periosteal distraction was associated with improved limb-related outcomes (shorter healing time, fewer major amputations, lower recurrence) compared with standard treatment in advanced ischemic diabetic foot ulcers, and prospective controlled studies are needed to confirm these findings.
Patients treated with tibial periosteal distraction (TPD) had a significantly shorter median ulcer healing time than those receiving standard treatment.
TPD was associated with a lower major amputation rate than standard treatment.
TPD was associated with a markedly lower ulcer recurrence rate.
In regression analyses, TPD remained significantly associated with shorter healing time and reduced amputation risk.
Imaging and histopathology showed changes consistent with increased vascularity in TPD-treated limbs.
The study's retrospective design limits conclusions, and prospective controlled studies are needed to confirm the findings.
This study looked at a surgical technique called tibial periosteal distraction, which is used for diabetic foot ulcers where blood flow to the leg is poor. The researchers reviewed records of 249 patients at three hospitals: 107 had the procedure and 142 received standard wound care and procedures to restore blood flow. The two groups were similar at the start. Patients who had the procedure healed faster (a median of 26 days versus 45 days), had fewer major amputations (35.5% versus 64.8%), and had far fewer recurrences of ulcers (2.8% versus 20.4%). Scans and tissue examinations also suggested that new small blood vessels or collateral vessels had formed in the treated legs, which may help explain the results. This research suggests the technique may help save limbs and speed healing in people with severe diabetic foot ulcers. However, because the study looked back at existing records rather than randomly assigning patients to treatments, other factors may have influenced the results. The authors say prospective controlled studies are needed to confirm these findings.
Qiu L, Liu Y, Zhao Y, Zhu Y, Yan Y, Jiang Z, et al.. (2026). Tibial Periosteal Distraction Technique Promotes Diabetic Foot Ulcer Healing and Improves Limb Preservation Rates: A Multicentre Cohort Study.. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. https://doi.org/10.1111/wrr.70216