AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026020012
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ORIGINAL RESEARCH ARTICLE

Tibial transverse transport promotes diabetic wound healing via angiogenic growth factors, anti-inflammatory response, and progenitor cell mobilization

Shuanji Ou1,2† ,  Xiaodong Wu1,3† ,  Jianping Wen1 ,  Jiabao Liu1 ,  Jiatao Lei1 ,  Tingyu He1 ,  Jiafu Xie1 ,  Rongshen Yang1 ,  Wei Zeng1 ,  Changliang Xia1,2 ,  Pengcheng Chen1,2 ,  Changpeng Xu1,2* ,  Yong Qi1,2*
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1 Department of Orthopedic, Orthopedic Center, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
2 Department of Orthopedic, Guangdong Traditional Medical and Sports Injury Rehabilitation Research Institute, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
3 Department of Orthopedic, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, Guangdong, China
†These authors contributed equally to this work.
EJMO, 026020012 https://doi.org/10.36922/EJMO026020012
Received: 7 January 2026 | Revised: 6 February 2026 | Accepted: 13 February 2026 | Published online: 20 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction:  Tibial transverse transport (TTT), a technique derived from the Ilizarov method, has shown clinical efficacy in treating recalcitrant diabetic foot ulcers by promoting angiogenesis. However, its underlying molecular mechanisms remain unclear.

Objectives: This study aimed to investigate the mechanisms by which TTT influences wound healing in a rat model of type 2 diabetes mellitus (T2DM).

Methods: Thirty-six male Sprague–Dawley rats were induced to develop T2DM via a high-fat diet and low-dose streptozotocin. They were randomized into three groups: sham surgery, external fixator application without transport, and active TTT surgery. A full-thickness excisional wound was created on the dorsum of the right foot. Wound area was measured photographically on days 0, 3, 6, 9, 12, and 15. Serum levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF), interleukin-10 (IL-10), and granulocyte colony-stimulating factor (G-CSF) were quantified using enzyme-linked immunosorbent assay on days 9 and 15.

Results: The TTT group exhibited a significantly accelerated reduction in wound area from day 9 onwards compared to the sham and fixator groups (p < 0.05). Concomitantly, serum levels of VEGF, bFGF, PDGF, IL-10, and G-CSF were significantly elevated in the TTT group at both time points.

Conclusion: We established a T2DM rat model of TTT surgery. Our findings suggest that the TTT technique accelerates diabetic wound healing, potentially through a multifaceted mechanism involving enhanced serum levels of key angiogenic growth factors, promotion of an anti-inflammatory microenvironment (via IL-10), and mobilization of endothelial progenitor cells (potentially via G-CSF).

Keywords
Tibial transverse transport
Diabetic foot ulcers
Rat model
Funding
This work was supported by the Medical Research Foundation of Guangdong Province (No. B2024038), Guangzhou Science and Technology Plan Project (No. 2024A03J1132), and the Affiliated Guangdong Second Provincial General Hospital of Jinan University (No. 2024D002).
Conflict of interest
The authors declare that there is no duality of interest associated with this manuscript.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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