Transverse Cortical Tibial Transport (TTT)

Transverse Cortical Tibial Transport (TTT) is an experimental treatment that uses a technique called distraction osteogenesis to encourage new blood vessel formation within the body and hence increase the blood flow to your leg or area of injury. There is evidence that it has been successful in treating stubborn ulceration in both limbs with poor blood supply and in those with advanced diabetes. Theoretically it can also speed up the rate of fracture healing and reduce the risk of a none union (the term used when a fracture doesn't heal). 

Your surgeon will use a device, often called the spider, fixed to your leg to perform the bony distraction needed to stimulate the new blood vessel formation. You will have to use the dial on the device to perform the distraction (called "turns"). This can be done at home. The process takes 28 days in total and the device remains on your leg for 6-8 weeks. Once finished, it is removed in the clinic with inhaled analgesia.   

The x-rays above and on the left are intra-operative images showing the window of bone and how far it moves (or distracts). This movement is what causes the effect of increasing blood flow to the limb. From the outside, you will not notice anything different and the process is sometimes uncomfortable immediately after the turn but settles down within minutes. Most patients feel it is hot but not painful.

You can walk without any restrictions whilst the device is in place and we encourage all our patients to try and continue life as if the device is not there. The biggest change is that the device cannot get wet and therefore you must cover the device when bathing and performing personal hygiene. Your turns can be split into 4 quarters per day or done all in one go, whichever suits you!

A link to a protection bag for your limb whilst showering is shown below. Please take care when bathing as getting it wet can cause infection.

Pin site care is performed once per week whilst the device is in place, it is really important that this is performed to avoid a pin site infection. A video on how to do this is shown below and was kindly made by our specialist Nurse, Rex Turita.