BioDynamik Science

[bi′o·dy·nam′ik] - (adj)

  1. pertaining to the effects of dynamic processes, such as motion or force, on living tissues

  2. referring to a holistic and regenerative approach to biological processes that enhance the self-sustaining vitality and growth of living organisms

400 BC - Hippocrates professes there is a natural healing force within each of us

Hippocrates (460-370 BC), the ancient Greek physician known as the "Father of Modern Medicine", believed that the human body has the power to heal itself. He believed that the natural healing force within each person is the greatest force in getting well.

1900s - Codivilla first describes distraction osteogenesis

Alessandro Codivilla first described distraction osteogenesis (DO) in 1905 as a surgical technique to lengthen limbs that were abnormally short due to injury, disease, or malformation. DO is a bone regeneration process that involves gradually separating bone segments to create a callus, which is then stretched to form new bone.

Reference: ©2012 Hamdy et al. (7)

Reference: ©2012 Hamdy et al. (7)

1950s - Gavriil Ilizarov discovers the Law of Tension-Stress

The "Law of Tension-Stress" refers to a biological principle stating that applying slow, gradual tension (pulling force) to living tissues can stimulate their growth and regeneration by activating cellular processes, essentially promoting the development of new tissue where tension is applied.

1970s - Ilizarov uses transverse distraction to treat vascular ischemic diseases

Ilizarov discovered that transverse distraction has strong potential for vascular regeneration. His method, which uses an external fixator to gently pull on tissue, promotes the growth of new blood vessels, nerves, and muscle. This technique proved effective for treating Buerger's disease and chronic limb ischemia. By stimulating neovascularization the method restores circulation, improves tissue viability, and can prevent amputation.

Reference: Ilizarov, G.A. (1992) Transosseous Osteosynthesis | Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue (Book)

Reference: Ilizarov, G.A. (1992) Transosseous Osteosynthesis | Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue (Book)

Reference: Yue‐Liang Zhu et all (2021) Ilizarov technology in China: a historic review of thirty‐one years

Reference: Yue‐Liang Zhu et all (2021) Ilizarov technology in China: a historic review of thirty‐one years

2001 - Tibial cortex transverse transport (TTT) introduced to China by Dr. Long Qu

TTT surgery is an extension of the Ilizarov technique. Based on the law of tension-stress, its primary function is to rebuild microcirculation which can relieve ischemic symptoms and promote wound healing. TTT technique is mainly used in the treatment of chronic ischemic diseases of the lower extremities.

2010s - Dr. Qikai Hua uses TTT to treat diabetic foot gangrene

By 2019, Dr. Qikai Hua had successfully treated over 500 cases of diabetic foot gangrene using the TTT technique. The remarkable effects of this approach—improving local blood supply and promoting tissue repair—have been consistently verified in the treatment of ischemic diseases.

Hua QK, Qin SH, Kuang XC, Chen Y, Qu L, Zhao JM. (2020) Treatment experiences of 516 cases of diabetic foot treated with tibial transverse transport. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ;34:959–63.

Source: Introduction to the sources and applications of external fixators for orthopedics, https://docbook.com .cn/information/409

Source: Introduction to the sources and applications of external fixators for orthopedics, https://docbook.com .cn/information/409

2020s - TTT reaches the West

With its introduction to the Western world, TTT brings a breakthrough for ischemic foot ulcers, showcasing the same proven efficacy observed in China.

Mechanism of Action

Tibial cortex transverse transport (TTT)

TTT uses controlled mechanical stress to stimulate angiogenesis by mobilizing wound-healing cells, activating growth factors, and recruiting bone marrow-derived stem cells. These mechanisms support vascular growth and tissue repair in ischemic conditions. While similar to the processes in distraction osteogenesis, TTT focuses on vascular regeneration, enhancing blood flow and healing in compromised tissues.

Osteotomy

The TTT procedure involves creating a surgically planned fracture, or osteotomy, in the bone. This controlled break triggers an inflammatory reaction that forms a hematoma, stabilizing the fracture site and attracting immune cells and growth factors essential for healing. This hematoma is the initial step in the bone healing cascade, supporting the body’s natural process of repair and regeneration.

Immunomodulation

The tension stress on the healing tissues trigger immunomodulation, shifting the pro-inflammatory environment to one that promotes wound repair. This tension-induced stimulus encourages macrophage polarization from the pro-inflammatory M1 type to the reparative M2 type, facilitating the release of anti-inflammatory cytokines and growth factors essential for tissue regeneration.

Enhanced Growth Factors

During the distraction phase of TTT, levels of growth factors critical for angiogenesis—such as VEGF, bFGF, EGF, and PDGF—are not only elevated but remain sustained even through the retraction phase and after treatment completion. This prolonged elevation creates a rich environment that continually supports stem cell activation and angiogenesis.

Angiogenesis

The growth of new blood vessels and the restoration of microcirculation through angiogenesis enhance perfusion to ischemic tissues, supplying vital oxygen and nutrients needed for effective cell function and wound healing. This newly formed perfusion network directly supports the healing process by delivering a continuous supply of essential resources to metabolically active cells, thereby promoting robust tissue regeneration and recovery in ischemic and chronic wounds.

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Clinical Impact

Tibial cortex transverse transport (TTT)

Y. Chen et al. (2022) Effect of tibial cortex transverse transport in patients with recalcitrant diabetic foot ulcers: A prospective multicenter cohort study. Journal of Orthopaedic Translation 36 (2022) 194–204

CTA images reveal angiogenesis through newly grown blood vessels extending into peripheral tissues.

Increased perfusion results in greater blood volume and improved blood flow.

Y. Chen et al. (2022) Effect of tibial cortex transverse transport in patients with recalcitrant diabetic foot ulcers: A prospective multicenter cohort study. Journal of Orthopaedic Translation 36 (2022) 194–204

Y. Chen et al. (2022) Effect of tibial cortex transverse transport in patients with recalcitrant diabetic foot ulcers: A prospective multicenter cohort study. Journal of Orthopaedic Translation 36 (2022) 194–204

Results indicate accelerated healing, with 93% of patients healed by six months compared to 41% with conventional treatments.

Restored microcirculation reduces ulcer recurrence, achieving a limb salvage rate of 96% compared to 67% at two years.

LATEST STORIES

Continue Reading about TTT

Exploring Tibial Cortex Transverse Transport (TTT) for Limb Preservation #ActAgainstAmputation

We are pleased to highlight more initial data with Tibial Cortex Transverse Transport (TTT). This novel approach offers a potential additional intervention for patients with chronic limb-threatening ischemia (CLTI) and severe diabetic foot ulcers (DFUs).

Tibial Transverse Transport (TTT), Angiogenesis, and Limb Preservation: More support as an adjunct to care? #ActAgainstAmputation #DiabeticFoot #CLTI

A recent study published in ScienceDirect has explored the role of tibial transport in limb preservation and wound healing for patients with diabetes and peripheral artery disease8.

What is the induced membrane technique for bone/wound healing and how can it help us #ActAgainstAmputation ?

A recent study published in the Chinese Journal of Tissue Engineering Research presents an innovative approach for treating diabetic foot ulcers through periosteal distraction. This technique, grounded in Ilizarov’s tension

Modified Tibial Cortex Transverse Transport (TTT): Yet more reported data for limb preservation? #ActAgainstAmputation #DiabeticFoot

Diabetic foot ulcers (DFUs) are a significant global health concern, affecting a substantial number of individuals with diabetes. These ulcers often present challenges in achieving healing, leading to prolonged non-healing and, in some cases, necessitating amputation.

Potential Advance in Diabetic Wound Healing? Bone Transport and the Role of Small Extracellular Vesicles #TTT #TibialTransport #ActAgainstAmputation #Mechanism #WoundHealing #DiabeticFoot

More on what I’d like to call “therapeutic distress signals”. Like NPWT, which works on skin matrices, could Ilizarov, properly used, stimulate angiogenesis at a distance? Even more data supporting a potential advance in diabetic wound...

More on the Potentially Innovative Approach to Neuroischemic Diabetic Foot Ulcers: Modified Tibial Cortex Transverse Transport

Diabetic foot ulcers (DFUs) are a common and severe complication of diabetes, often leading to lower extremity amputations. Traditional treatments, while varied, do not always prevent the progression of these ulcers, particularly in more advanced stages.

Exploring New Frontiers in Diabetic Foot Treatment: The Role of Tibial Cortex Transverse Transport #ActAgainstAmputation

Diabetic foot, a severe complication of diabetes, poses a significant challenge in medical treatment and patient care. Traditional approaches have often focused on managing symptoms and preventing further deterioration, but recent research offers a glimpse...

Innovative Periosteal Distraction Technique for Diabetic Foot Ulcer Treatment #ActAgainstAmputation #PeriostealDistraction #PAD #CLTI

A recent study published in the Chinese Journal of Tissue Engineering Research presents an innovative approach for treating diabetic foot ulcers through periosteal distraction. This technique, grounded in Ilizarov’s tension

Outcomes of integrated surgical wound treatment mode based on tibial transverse transport for diabetic foot wound #ActAgainstAmputation @ALPSLimb #DiabeticFoot

Congratulations to Chang and coworkers on this effort. This makes us want to reach back to work from our team a dozen or so years ago, where we failed to really explore this fascinating area of creating, in essence, a distress signal