Transverse Tibial Bone Transport

Transverse tibial bone transport (TBT) is a limb-salvage procedure used to treat chronic, non-healing wounds—particularly in patients with poor circulation, such as those with diabetes or peripheral arterial disease. The procedure involves cutting a small segment of the tibia and gradually moving it sideways using an external fixator. This controlled movement stimulates new blood vessel growth (angiogenesis) and increases blood flow to the lower leg and foot.

By improving circulation, TBT helps chronic or treatment-resistant wounds heal and significantly reduces the risk of amputation. It is most often used when other treatments have failed and is designed to restore blood flow, promote healing, and preserve limb function.

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What Conditions Does It Treat?

Chronic, non-healing foot or leg wounds

that have not responded to standard wound care

Severe peripheral arterial disease (PAD) or critical limb ischemia (CLI)

with limited revascularization options

Patients who are not candidates for bypass surgery or stenting

due to small, blocked, or poor-quality vessels

Learn More about Surgery & Recovery
More about Surgery & Recovery

How Do We Treat with Transverse Tibial Bone Transport

  • Stimulates angiogenesis—the gradual movement of the bone segment encourages new blood vessel growth in the lower leg
  • Improves local circulation—enhanced blood flow delivers more oxygen and nutrients to poorly perfused tissues
  • Promotes wound healing—increased perfusion supports closure of chronic ulcers and ischemic wounds

Surgery Results and Goals

Reduction in wound size through improved vascular supply and increased cellular activity

Resolution of chronic, non-healing wounds that were previously unresponsive to standard treatment

Improved conditions for bone fusion or limb reconstruction by increasing local osteogenic activity

Our ultimate goal is long-term limb preservation by addressing both the vascular and mechanical factors that contribute to non-healing wounds.

Recovery and Results

Detailed Typical Post-Op Course for Transverse Tibial Bone Transport

Immediate Post-Op (Days 0–7)

  • Hospital stay or closely monitored outpatient recovery, depending on individual comorbidities
  • Daily pin-site care using sterile technique to prevent infection
  • Pain control with oral medications as needed
  • Non-weight-bearing on the operative limb
  • Initial follow-up appointment scheduled within the first week

Latency Phase (Days 0–7 Post-Op)

  • No movement of the bone segment—allows initial healing at osteotomy site
  • Close monitoring for signs of infection, wound complications, or hardware issues

Distraction Phase (Typically Days 8–28)

  • Begin distraction (bone movement) of the bone segment at 0.25 mm every 6 hours (1 mm/day) using the Orthofix adjustment knobs
  • Patients or caregivers may be trained to perform the daily adjustments
  • Continue non-weight-bearing
  • Weekly or biweekly X-rays to monitor bone transport progress and regenerate formation

Consolidation Phase (After 3–4 Weeks of Distraction)

  • Distraction stops, and the bone segment remains in its new position
  • Allow time for the new bone (regenerate) to harden and mature
  • Phase may last 6–8 weeks or longer, depending on individual patient factors
  • Continue strict pin-site care and close monitoring for any signs of infection

Transition to Weight-Bearing (Typically 8–12 Weeks Post-Op)

  • Gradual transition from partial to full weight-bearing as tolerated and guided by X-ray findings
  • Use of a CAM boot, walker, or crutches during the weight-bearing transition
  • Continued physical therapy to improve ankle and foot mobility

Frame Removal (Usually 12–16 Weeks Post-Op)

  • Performed once X-rays confirm regenerate consolidation
  • Completed as an outpatient procedure or minor surgery under sedation or anesthesia
  • Followed by a brace or orthosis to protect the limb for several additional weeks

Long-Term Follow-Up

  • Monitoring for wound closure, ulcer recurrence, or any signs of reinfection
  • Possible use of custom orthotics or offloading footwear to reduce pressure and protect vulnerable areas
  • Ongoing follow-up every 3–6 months for high-risk patients to ensure continued healing and limb preservation
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