Preliminary application of ulnar cortex transverse transport technique in treatment of upper extremity thromboangiitis obliterans_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MO Xiaojin ^1,2 , HE Chunnian ³ , ZHOU Jian ^1,2 , CHEN Wei ^1,2 , NIE Kaiyu ^1,2 ,  WEI Zairong ^1,2 ,  CHANG Shusen ^1,2

1. Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;
2. The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;
3. Day Surgery Ward, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;

Corresponding author：

WEI Zairong, Email: zairongwei@163.com; CHANG Shusen, Email: 13511848567@163.com

Keywords：

Thromboangiitis obliterans; Ilizarov technique; ulcer; upper limb; distraction osteogenesis

DOI：

10.7507/1002-1892.202404096

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Objective To investigate the feasibility and effectiveness of ulnar cortex transverse transport technique in treating upper extremity thromboangiitis obliterans (TAO). Methods A retrospective analysis was conducted on the clinical data of 7 male patients with upper extremity TAO who were admitted and met the inclusion criteria between January 2019 and July 2022. The patients ranged in age from 32 to 50 years, with a mean age of 40.1 years. The disease duration ranged from 6 to 24 months, averaging 13.6 months. The smoking history ranged from 8 to 31 years, with a mean of 18.4 years. All patients presented with finger ulcers or gangrene, including 1 case affecting the thumb and index finger, 1 case affecting the index and middle fingers, 1 case affecting the middle and ring fingers, 1 case affecting only the ring finger, and 3 cases affecting the ring and little fingers. The preoperative visual analogue scale (VAS) score was 9.1±0.7. All patients underwent treatment with the ulnar cortext transverse transport technique. The wound healing time and the disappearance time of rest pain were recorded. The VAS score was used to assess the degree of hand pain before and after operation. Serum interleukin 6 (IL-6) levels were measured before operation and at 1 month after operation. Computed tomography angiography (CTA) of the affected limb was performed before operation and at 3 months after operation to evaluate changes in blood vessels. The clinical outcomes were evaluated at 1 year after operation based on the Patwa and Krishnan grading system. Results All 7 patients were followed up 12-17 months, with an average of 13.7 months. All patients experienced successful healing of ulcers, with wound healing time ranging from 14 to 21 days, averaging 17.3 days. During the follow-up, no complication occurred, and there was no recurrence of ulcers. The disappearance time of rest pain ranged from 8 to 15 days, averaging 12.1 days. The pre- and post-operative (1-month) serum IL-6 levels were (25.1±5.9) pg/mL and (11.9±2.9) pg/mL, respectively, with a significant difference (t=5.363, P=0.002). CTA examination at 3 months after operation revealed partial revascularization of upper extremity arteries and establishment of collateral circulation, showing significant improvement compared to preoperative status. The VAS scores at 1, 7, 28 days, and 6 months postoperatively were 6.4±0.8, 3.7±0.8, 0.6±0.8, and 0.1±0.4, respectively, all of which significantly improved compared to preoperative scores (P<0.05). Furthermore, the VAS scores gradually decreased over time, with significant differences observed between postoperative time points (P<0.05). At 1 year after operation, the effectiveness of all 7 patients were evaluated as excellent based on the Patwa and Krishnan grading system. Conclusion The ulnar cortex transverse transport technique can improve blood circulation in the upper limb of patients with TAO, reconstruct microcirculation, inhibit inflammation, promote ulcer healing, and alleviate limb pain.

Citation： MO Xiaojin, HE Chunnian, ZHOU Jian, CHEN Wei, NIE Kaiyu, WEI Zairong, CHANG Shusen. Preliminary application of ulnar cortex transverse transport technique in treatment of upper extremity thromboangiitis obliterans. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(10): 1242-1248. doi: 10.7507/1002-1892.202404096 Copy

1.	Liu Z, Zhou C, Guo H, et al. Knowledge mapping of global status and trends for thromboangiitis obliterans: A bibliometrics and visual analysis. J Pain Res, 2023, 16: 4071-4087.
2.	Gundogmus CA, Samadli V, Sorkun M, et al. The effect of smoking cessation on the technical success of endovascular treatment for thromboangiitis obliterans. J Vasc Interv Radiol, 2023, 34(6): 1038-1044.
3.	Shimizu Y, Murohara T. Therapeutic angiogenesis for thromboangiitis obliterans. Circ J, 2023, 87(9): 1238-1239.
4.	Ng KLB, Hsieh MW, Lin YN, et al. Application of nanofat grafting to rescue a severe ischaemic hand with thromboangiitis obliterans: A case report about promising salvage procedure. Medicine (Baltimore), 2021, 100(42): e27577. doi: 10.1097/MD.0000000000027577.
5.	Raimbeau A, Pistorius MA, Goueffic Y, et al. Digital ischaemia aetiologies and mid-term follow-up: A cohort study of 323 patients. Medicine (Baltimore), 2021, 100(20): e25659. doi: 10.1097/MD.0000000000025659.
6.	Salimi J, Cheraghali R, Omrani Z, et al. Surgical treatment options for Buerger’s disease (experience with 315 cases in Iran). Med J Islam Repub Iran, 2022, 36: 134. doi: 10.47176/mjiri.36.134.
7.	Galyfos G, Liakopoulos D, Chamzin A, et al. A systematic review and meta-analysis of early and late outcomes after endovascular angioplasty among patients with thromboangiitis obliterans and chronic limb ischemia. J Vasc Surg, 2023, 77(5): 1534-1541.
8.	徐道非, 胡蓉, 余庆龙, 等. 胫骨横向搬移技术的临床应用及其诱导血管再生机制的研究进展. 中华骨与关节外科杂志, 2023, 16(9): 854-859.
9.	Shionoya S. Diagnostic criteria of Buerger’s disease. Int J Cardiol, 1998, 66 Suppl 1: S243-S245, S247.
10.	Olin JW. Thromboangiitis obliterans (Buerger’s disease). N Engl J Med, 2000, 343(12): 864-869.
11.	Patwa JJ, Krishnan A. Buerger’s disease (thromboangiitis obliterans)—Management by Ilizarov’s technique of horizontal distraction. A Retrospective Study of 60 Cases. Indian J Surg, 2011, 73(1): 40-47.
12.	林世泓, 杨雄刚, 耿翔, 等. 胫骨横向骨搬移技术对糖尿病足的治疗作用及其生物学机制研究进展. 中国临床医学, 2023, 30(1): 12-17.
13.	Liu Z, Xu C, Yu YK, et al. Twenty years development of tibial cortex transverse transport surgery in PR China. Orthop Surg, 2022, 14(6): 1034-1048.
14.	常树森, 杨尉, 宋荷花, 等. 胫骨横向骨搬移技术联合改良神经松解术治疗糖尿病足溃疡. 中国修复重建外科杂志, 2023, 37(11): 1410-1417.
15.	Ou S, Xu C, Yang Y, et al. Transverse tibial bone transport enhances distraction osteogenesis and vascularization in the treatment of diabetic foot. Orthop Surg, 2022, 14(9): 2170-2179.
16.	Yang Y, Li Y, Pan Q, et al. Tibial cortex transverse transport accelerates wound healing via enhanced angiogenesis and immunomodulation. Bone Joint Res, 2022, 11(4): 189-199.
17.	Tian W, Feng B, Zhang L, et al. Tibial transverse transport induces mobilization of endothelial progenitor cells to accelerate angiogenesis and ulcer wound healing through the VEGFA/CXCL12 pathway. Biochem Biophys Res Commun, 2024, 709: 149853. doi: 10.1016/j.bbrc.2024.149853.
18.	Kong LC, Li HA, Kang QL, et al. An update to the advances in understanding distraction histogenesis: From biological mechanisms to novel clinical applications. J Orthop Translat, 2020, 25: 3-10.
19.	Zou C, Liu L, Huang C, et al. Baiying qingmai formulation ameliorates thromboangiitis obliterans by inhibiting HMGB1/RAGE/NF-κB signaling pathways. Front Pharmacol, 2022, 13: 1018438. doi: 10.3389/fphar.2022.1018438.
20.	Liu C, Kong X, Wu X, et al. Alleviation of A disintegrin and metalloprotease 10 (ADAM10) on thromboangiitis obliterans involves the HMGB1/RAGE/ NF-κB pathway. Biochem Biophys Res Commun, 2018, 505(1): 282-289.
21.	Fazeli B, Ligi D, Keramat S, et al. Recent updates and advances in Winiwarter-Buerger Disease (thromboangiitis obliterans): Biomolecular mechanisms, diagnostics and clinical consequences. Diagnostics (Basel), 2021, 11(10): 1736. doi: 10.3390/diagnos-tics11101736.
22.	Zhao L, Lei Y, Pang M, et al. An improved bone transport surgical method for treating chronic ischemic ulcers (thromboangiitis obliterans). Front Surg, 2022, 9: 859201. doi: 10.3389/fsurg.2022.859201.
23.	Qi Y, Xu C, Wu X, et al. Thromboangiitis obliterans successfully treated with radius transverse transport. Asian J Surg, 2022, 45(12): 2808-2809.

1. Liu Z, Zhou C, Guo H, et al. Knowledge mapping of global status and trends for thromboangiitis obliterans: A bibliometrics and visual analysis. J Pain Res, 2023, 16: 4071-4087.
2. Gundogmus CA, Samadli V, Sorkun M, et al. The effect of smoking cessation on the technical success of endovascular treatment for thromboangiitis obliterans. J Vasc Interv Radiol, 2023, 34(6): 1038-1044.
3. Shimizu Y, Murohara T. Therapeutic angiogenesis for thromboangiitis obliterans. Circ J, 2023, 87(9): 1238-1239.
4. Ng KLB, Hsieh MW, Lin YN, et al. Application of nanofat grafting to rescue a severe ischaemic hand with thromboangiitis obliterans: A case report about promising salvage procedure. Medicine (Baltimore), 2021, 100(42): e27577. doi: 10.1097/MD.0000000000027577.
5. Raimbeau A, Pistorius MA, Goueffic Y, et al. Digital ischaemia aetiologies and mid-term follow-up: A cohort study of 323 patients. Medicine (Baltimore), 2021, 100(20): e25659. doi: 10.1097/MD.0000000000025659.
6. Salimi J, Cheraghali R, Omrani Z, et al. Surgical treatment options for Buerger’s disease (experience with 315 cases in Iran). Med J Islam Repub Iran, 2022, 36: 134. doi: 10.47176/mjiri.36.134.
7. Galyfos G, Liakopoulos D, Chamzin A, et al. A systematic review and meta-analysis of early and late outcomes after endovascular angioplasty among patients with thromboangiitis obliterans and chronic limb ischemia. J Vasc Surg, 2023, 77(5): 1534-1541.
8. 徐道非, 胡蓉, 余庆龙, 等. 胫骨横向搬移技术的临床应用及其诱导血管再生机制的研究进展. 中华骨与关节外科杂志, 2023, 16(9): 854-859.
9. Shionoya S. Diagnostic criteria of Buerger’s disease. Int J Cardiol, 1998, 66 Suppl 1: S243-S245, S247.
10. Olin JW. Thromboangiitis obliterans (Buerger’s disease). N Engl J Med, 2000, 343(12): 864-869.
11. Patwa JJ, Krishnan A. Buerger’s disease (thromboangiitis obliterans)—Management by Ilizarov’s technique of horizontal distraction. A Retrospective Study of 60 Cases. Indian J Surg, 2011, 73(1): 40-47.
12. 林世泓, 杨雄刚, 耿翔, 等. 胫骨横向骨搬移技术对糖尿病足的治疗作用及其生物学机制研究进展. 中国临床医学, 2023, 30(1): 12-17.
13. Liu Z, Xu C, Yu YK, et al. Twenty years development of tibial cortex transverse transport surgery in PR China. Orthop Surg, 2022, 14(6): 1034-1048.
14. 常树森, 杨尉, 宋荷花, 等. 胫骨横向骨搬移技术联合改良神经松解术治疗糖尿病足溃疡. 中国修复重建外科杂志, 2023, 37(11): 1410-1417.
15. Ou S, Xu C, Yang Y, et al. Transverse tibial bone transport enhances distraction osteogenesis and vascularization in the treatment of diabetic foot. Orthop Surg, 2022, 14(9): 2170-2179.
16. Yang Y, Li Y, Pan Q, et al. Tibial cortex transverse transport accelerates wound healing via enhanced angiogenesis and immunomodulation. Bone Joint Res, 2022, 11(4): 189-199.
17. Tian W, Feng B, Zhang L, et al. Tibial transverse transport induces mobilization of endothelial progenitor cells to accelerate angiogenesis and ulcer wound healing through the VEGFA/CXCL12 pathway. Biochem Biophys Res Commun, 2024, 709: 149853. doi: 10.1016/j.bbrc.2024.149853.
18. Kong LC, Li HA, Kang QL, et al. An update to the advances in understanding distraction histogenesis: From biological mechanisms to novel clinical applications. J Orthop Translat, 2020, 25: 3-10.
19. Zou C, Liu L, Huang C, et al. Baiying qingmai formulation ameliorates thromboangiitis obliterans by inhibiting HMGB1/RAGE/NF-κB signaling pathways. Front Pharmacol, 2022, 13: 1018438. doi: 10.3389/fphar.2022.1018438.
20. Liu C, Kong X, Wu X, et al. Alleviation of A disintegrin and metalloprotease 10 (ADAM10) on thromboangiitis obliterans involves the HMGB1/RAGE/ NF-κB pathway. Biochem Biophys Res Commun, 2018, 505(1): 282-289.
21. Fazeli B, Ligi D, Keramat S, et al. Recent updates and advances in Winiwarter-Buerger Disease (thromboangiitis obliterans): Biomolecular mechanisms, diagnostics and clinical consequences. Diagnostics (Basel), 2021, 11(10): 1736. doi: 10.3390/diagnos-tics11101736.
22. Zhao L, Lei Y, Pang M, et al. An improved bone transport surgical method for treating chronic ischemic ulcers (thromboangiitis obliterans). Front Surg, 2022, 9: 859201. doi: 10.3389/fsurg.2022.859201.
23. Qi Y, Xu C, Wu X, et al. Thromboangiitis obliterans successfully treated with radius transverse transport. Asian J Surg, 2022, 45(12): 2808-2809.

Chinese Journal of Reparative and Reconstructive Surgery

Preliminary application of ulnar cortex transverse transport technique in treatment of upper extremity thromboangiitis obliterans

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