Tibial Periosteal Distraction Technique Promotes Diabetic Foot Ulcer Healing and Improves Limb Preservation Rates: A Multicentre Cohort Study

ABSTRACT

Tibial periosteal distraction has emerged as a potential surgical approach for ischemic diabetic foot ulcers, but evidence from large multicentre cohorts remains limited. This multicentre retrospective cohort study aimed to evaluate whether tibial periosteal distraction improves limb‐related outcomes compared with standard treatment in patients with advanced ischemic diabetic foot ulcers. Between January 2023 and June 2025, 340 patients with diabetic foot ulcers were treated at three centres. After applying predefined inclusion and exclusion criteria, 249 patients were eligible for analysis: 107 underwent tibial periosteal distraction and 142 received standard wound care and revascularization procedures. Baseline characteristics were similar between groups. Primary outcomes were ulcer healing time, major amputation, and recurrence. Computed tomography angiography and histopathology were used to evaluate vascular and tissue changes. Tibial periosteal distraction was associated with significantly shorter median healing time (26 vs. 45 days; p  < 0.001), lower major amputation rate (35.5% vs. 64.8%; RR 0.55 [95% CI 0.41–0.74]; p  < 0.001), and lower recurrence rate (2.8% vs. 20.4%; RR 0.14 [95% CI 0.04–0.43]; p  < 0.001) compared with standard treatment. TPD significantly shortened ulcer healing time ( B  = 36.485, p  < 0.001) and reduced amputation risk (OR = 0.291, p  < 0.001) in patients with diabetic foot ulcers. Computed tomography angiography revealed enhanced collateral formation, and histopathologic examination showed morphological changes suggestive of increased vascularity in limbs treated with tibial periosteal distraction. In this multicentre retrospective cohort, tibial periosteal distraction was associated with improved limb‐related outcomes compared with standard treatment. Prospective controlled studies are needed to confirm these findings.