Comparison of Tibial Transverse Transport and Free Anterolateral Thigh Perforator Flap in the Treatment of Severe Diabetic Foot Ulcers: A Retrospective Study

Shunan Dong¹Jiyong Jiang²Sijie Yang^3*Qikai Hua^1*

• ¹First Affiliated Hospital, Guangxi Medical University, Nanning, China
• ²Guizhou Provincial People's Hospital, Guiyang, China
• ³People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China

Background Free anterolateral thigh perforator flap (ALTPF) reconstruction is a conventional approach for the treatment of diabetic foot ulcers (DFU), whereas tibial cortex transverse transport (TTT) represents an emerging alternative. However, direct comparative studies evaluating their therapeutic efficacy remain limited. Objectives To compare the therapeutic outcomes of TTT and ALTPF transplantation in the repair of severe DFU. Methods A retrospective analysis was performed on patients with DFU treated at the First Affiliated Hospital of Guangxi Medical University between January 2016 and December 2022. All patients underwent either TTT or ALTPF reconstruction. Treatment and follow-up data were obtained from the hospital's Computer Information Center and the outpatient follow-up system. Patient demographics and wound-related information were collected. Ulcer healing status was assessed using wound photographs and follow-up records, with healing time, recurrence, and amputation events documented. Foot sensory function was evaluated using the Semmes–Weinstein monofilament test (SWMT) and nerve conduction velocity measurements, while postoperative foot function was assessed according to the Maryland Foot Score. Results A total of 174 patients with DFU were included in this study, of whom 88 underwent TTT and 86 received ALTPF reconstruction. The TTT group had significantly shorter operative time, less intraoperative blood loss, and a lower transfusion rate than the ALTPF group (P < 0.05). The ulcer healing rate was higher in the TTT group (98% vs 88%, P = 0.015), whereas the recurrence and major amputation rates were significantly lower (both P < 0.05). The TTT group also showed a higher rate of positive SWMT and faster nerve conduction velocity compared with the ALTPF group (P < 0.05), along with better Maryland Foot Scores. Two cases of pin-tract infection occurred in the TTT group, while flap necrosis developed in nine cases in the ALTPF group. Conclusions TTT demonstrated superior therapeutic efficacy to ALTPF in the management of severe DFU. TTT offered advantages including shorter operative time, reduced blood loss, lower transfusion and complication rates, higher healing rate, and better functional recovery. However, further randomized controlled trials are warranted to validate these findings.