Efficacy of tibial transverse transport combined with platelet-rich plasma versus platelet-rich plasma alone in the treatment of diabetic foot ulcers: A meta-analysis

Abstract

BackgroundDiabetic foot ulcers (DBFU) are one of the main complications of diabetes. Platelet-rich plasma (PRP) treatment is a commonly used treatment option. Tibial transverse transport (TTT) also has a therapeutic effect on DBFU. Some studies have found that the TTT combined with PRP (TTT&PRP) has a significant effect on DBFU. MethodsPubMed, Cochrane Library, Web of Science, EMBASE, Chinese Biomedical Literature, CNKI, VIP, and Wanfang databases were used to find literature on the treatment of DBFUs using the TTT and PRP treatment according to the inclusion criteria. The specific inclusion criteria are as follows: (1) research type: clinical controlled trials, including retrospective cohort and randomized controlled studies; (2) diagnosis of DBFUs that does not include a definitively diagnosed traumatic ulcer; (3) original materials of Chinese and English literature published in full text. The exclusion criteria are: (1) the research group was not defined or grouped; (2) nonrandomized controlled trials, non-cohort studies, non-case-control studies, retrospective studies, and case reports; (3) repetitive research and animal experimentation; (4) ulcers caused by other diseases; (5) conservative treatment or no use of invasive treatment methods. Review Manager software (version 5.3) was used to conduct a meta-analysis of the included results. ResultThe literature included 6 randomized controlled studies, including 508 patients, 254 patients in the PRP treatment group, and 254 patients in the TTT&PRP group. The meta-analysis results showed that in terms of treatment efficacy, the TTT&PRP combined treatment group had a higher efficacy than the PRP group. After treatment, the TTT&PRP group had better treatment effects in psychological function, physiological function, and social function compared to the PRP group. After treatment, the TTT&PRP group showed a significant increase in serum epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and platelet-derived growth factor (PDGF) levels compared to the PRP group. In terms of wound healing after treatment, the TTT&PRP group performed better than the PRP group in terms of postoperative wound reduction rate, bacterial clearance rate, granulation tissue coverage rate, and granulation tissue growth thickness. ConclusionTTT combined with PRP was more effective than PRP alone in treating DBFUs.