Transverse Tibial Transport: A Limb Preservation Option for Patients with Severe Circulation Problems

    Transverse Tibial Transport: A Limb Preservation Option for Patients with Severe Circulation Problems

    When blood flow to the foot becomes critically reduced—often due to diabetes or peripheral artery disease—patients can develop non-healing wounds, infections, or gangrene. In the most severe cases, the risk of amputation becomes very real.

    Traditionally, treatment has focused on vascular procedures designed to restore blood flow to the foot. However, there is an emerging limb-preservation technique called Transverse Tibial Transport (TTT) that works through a completely different biological mechanism.

    At the Advanced Foot and Ankle Center of San Diego, this innovative technique may be considered for carefully selected patients as part of a comprehensive limb preservation strategy.

    The Challenge: Critical Limb Ischemia

    Many patients who develop severe foot wounds suffer from a condition called Peripheral Artery Disease, where arteries that supply the legs and feet become narrowed or blocked.

    In advanced cases—often referred to as Chronic Limb-Threatening Ischemia—the body simply cannot deliver enough oxygen and nutrients to the tissues of the foot. This leads to:

    • Chronic non-healing ulcers

    • Severe infections

    • Tissue death (gangrene)

    • Risk of major amputation

    For many years, treatment has focused on restoring blood flow through vascular interventions.

    Traditional Approach: Vascular Procedures

    Most patients with severe circulation problems are treated by vascular specialists using procedures such as:

    • Angioplasty – inflating a small balloon inside the artery to open a blockage

    • Vascular Stenting – placing a metal scaffold to keep an artery open

    • Peripheral Artery Bypass Surgery – surgically rerouting blood flow around blocked arteries

    These procedures can be extremely valuable and lifesaving. However, they are not always possible or successful.

    Some patients have:

    • Diffuse small-vessel disease

    • Multiple failed revascularization attempts

    • Arteries that are too diseased for bypass

    • Persistent wounds despite improved blood flow

    For these patients, additional limb-preserving strategies may be necessary.

    A Different Concept: Transverse Tibial Transport

    Transverse Tibial Transport is based on a fascinating biological principle: controlled bone movement can stimulate the body to grow new blood vessels.

    The technique was developed from principles of Distraction Osteogenesis, originally pioneered by orthopedic surgeon Gavriil Ilizarov.

    In distraction osteogenesis, slowly moving bone segments stimulates the body to generate new bone, soft tissue, and blood vessels. Surgeons discovered that these same biological signals can dramatically improve microcirculation in the limb.

    How the Procedure Works

    During a Transverse Tibial Transport procedure:

    1. A small rectangular segment of bone is created in the Tibia (the shin bone).

    2. This bone segment remains attached to the surrounding tissues.

    3. A specialized external device slowly moves the bone segment side-to-side over time.

    4. This gradual motion stimulates:

      • Growth of new blood vessels

      • Increased circulation to the foot

      • Improved tissue healing capacity

    Unlike vascular procedures, this method does not open blocked arteries. Instead, it encourages the body to create new microvascular networks that improve blood flow to the foot.

    Why This Matters for Limb Preservation

    For patients with severe circulation problems, Transverse Tibial Transport may:

    • Improve blood supply to the foot

    • Promote healing of chronic ulcers

    • Reduce infection risk

    • Lower the chance of major amputation

    In other words, it provides another pathway toward saving the limb when traditional options are limited.

    Not a Replacement for Vascular Care

    It is important to understand that Transverse Tibial Transport does not replace vascular procedures.

    In many cases, the best outcomes occur when:

    • Vascular specialists optimize arterial blood flow

    • Limb preservation surgeons address infection and wounds

    • Advanced orthopedic techniques stimulate tissue regeneration

    This team-based approach is often necessary in the most complex cases of limb-threatening disease.

    Why Surgical Expertise Matters

    Transverse Tibial Transport is a technically demanding procedure that requires specialized training in:

    • Limb reconstruction

    • Deformity correction

    • External fixation techniques

    • Advanced limb salvage surgery

    These skills are derived from the field of limb reconstruction surgery, which uses precise bone and soft tissue manipulation to restore function and preserve limbs.

    Why the Advanced Foot and Ankle Center of San Diego Is Uniquely Positioned

    The Advanced Foot and Ankle Center of San Diego focuses extensively on complex limb preservation and reconstruction.

    This includes expertise in:

    • Limb salvage surgery

    • Bone reconstruction and deformity correction

    • External fixation techniques

    • Advanced wound management

    Because Transverse Tibial Transport is based on the principles of limb reconstruction, it fits naturally within a practice that specializes in orthopedic limb salvage and complex lower extremity surgery.

    This type of training allows for:

    • Careful patient selection

    • Precise surgical technique

    • Integration with wound care and infection management

    • Comprehensive limb preservation strategies

    Who Might Be a Candidate?

    Patients who may benefit from evaluation for Transverse Tibial Transport often have:

    • Severe diabetic foot ulcers

    • Chronic non-healing wounds

    • Poor circulation in the foot

    • Limited vascular surgical options

    • High risk for amputation

    A detailed evaluation is required to determine whether this procedure is appropriate.

    The Goal: Saving the Limb

    For patients facing the possibility of major amputation, every additional limb-preserving option matters.

    Transverse Tibial Transport represents a powerful new tool in the fight against limb loss, working through the body’s own biological ability to regenerate blood vessels and heal tissue.

    Learn More

    Patients with chronic foot wounds or circulation problems should seek evaluation from specialists experienced in limb preservation and reconstructive foot and ankle surgery.

    Early intervention often provides the best opportunity to heal wounds, control infection, and preserve the limb.