Chinese Journal of Tissue Engineering Research ›› 2022, Vol. 26 ›› Issue (32): 5236-5241.doi: 10.12307/2022.910

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Periosteum distraction for the treatment of diabetic foot ulcer: theoretical basis and clinical verification

Liu Jie1, 2, 5, Hua Qikai1, 5, Li Shanlang3, Yu Jie1, Su Hongjie1, 2, 4, 5, Ding Yi1, 5, Zhao Yongxin1, 2, 5, Su Yongfeng1, 5, Chen Yan1   

  1. 1Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University; 2Collaborative Innovation Center of Regenerative Medicine and Medical Biological Resources Development and Application, Guangxi Medical University; 3Department of Sports Medicine, Affiliated Hospital of Youjiang Medical College for Nationalities; 4Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University; 5Guangxi Diabetic Foot Limb Salvage Engineering and Research Center
  • Received:2021-12-21 Accepted:2022-01-20 Online:2022-11-18 Published:2022-05-14
  • Contact: Chen Yan, MD, Master’s supervisor, Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
  • About author:Liu Jie, Master candidate, Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China; Collaborative Innovation Center of Regenerative Medicine and Medical Biological Resources Development and Application, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China; Guangxi Diabetic Foot Limb Salvage Engineering and Research Center, Nanning 530021, Guangxi Zhuang Autonomous Region, China
  • Supported by:
    the National Natural Science Foundation of China, Nos. 82060406 and 81601930 (to CY); China Postdoctoral Science Foundation, No. 2019M650235 (to CY); Guangxi Zhuang Autonomous Region Natural Science Foundation, No. 2017GXNSFAA198318 (to CY); Key Research and Development Plan of Qingxiu District, Nanning City, Guangxi Zhuang Autonomous Region, Nos. 2021003 and 2020053 (to CY and HQK); Clinical Research Climbing Plan of the First Affiliated Hospital of Guangxi Medical University, No. YYZS2020010 (to HQK)

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Abstract: BACKGROUND: Periosteal distraction has been found to stimulate osteogenesis and angiogenesis; however, whether this technique can be used for the treatment of diabetic foot remains unclear. 
OBJECTIVE: To review the research progress of periosteal distraction in the promotion of osteogenesis and neovascularization, to clarify the theoretical basis of this technique for the treatment of diabetic foot, and to introduce its preliminary application in the treatment of diabetic foot. 
METHODS: Literature retrieval was conducted using computer in WanFang, CNKI, PubMed and Elsevier databases using the keywords of “distraction histogenesis, distraction osteogenesis, tibia transverse transport and diabetic foot, periosteal distraction osteogenesis, periosteal distraction and diabetic foot” in Chinese and English. Finally, 42 articles were included for analysis. 
RESULTS AND CONCLUSION: Based on Ilizarov’s law of tension-stress or the principle of distraction histogenesis, distraction osteogenesis has been used to treat bone defects, nonunion and other orthopedic diseases. The angiogenesis accompanying distraction osteogenesis gave birth to the technique of tibial transverse transfer, which has been successfully applied to refractory lower extremity ulcers including diabetic foot. Also based on the principle of distraction histogenesis, studies have found that a continuous, stable and slow distraction of the periosteum can promote bone and vascular regeneration, that is, the phenomenon of periosteal distraction osteogenesis and angiogenesis. The mechanism of this phenomenon may be related to the structure and composition of the periosteum. However, the current research on periosteal distraction mainly focuses on its osteogenic function in animal experiments but hardly in humans. Like tibial transverse transfer to promote angiogenesis for the treatment of diabetic foot, periosteal distraction angiogenesis may also be used to treat diabetic foot, which is the theoretical basis of periosteal distraction for the treatment of diabetic foot. Our preliminary clinical study has shown that this technique is effective in the treatment of diabetic foot. Periosteal distraction is simpler and shorter than the lateral tibial bone transfer because it does not require osteotomy. The periosteal distraction technique lacks the manipulation of tibial drilling and bone transfer and lacks the “fenestration decompression” of the bone marrow cavity. So, the periosteal distraction technique may be inferior to the lateral bone transfer of the tibia in terms of promoting angiogenesis and wound healing. In the future, the indications, contraindications, and specific mechanism of periosteal distraction still need to be explored.

Key words: law of tension-stress, distraction histogenesis, distraction osteogenesis, periosteal, periosteal distraction, periosteal distraction osteogenesis, diabetic foot

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