Fig. 2.

A typical case of mTTT. A 98-year-old male with 32-year type 2 diabetes mellitus. Ulcers, gangrene, and tissue necrosis were found on the right foot of the patient for more than 2 months before he coming to our hospital. During this period, debridement and conservative treatment were ineffective after dressing changes. He was diagnosed with DFU in 4D stage of TEXAS classification. The skin temperature of the dorsum of the foot, ankle-brachial index, transcutaneous oxygen partial pressure were 28.6 ​°C, 0.36 and 30 ​mmHg respectively before mTTT. After removal of necrotic tissue and mTTT treatment, the wound healed completely 3 months after the operation. The skin temperature on the dorsum of the foot was 34.8 ​°C, ankle-brachial index was 0.92, and the transcutaneous oxygen partial pressure was 46 ​mmHg at 3 months after operation. (a) The appearance of foot ulcers prior to the operation. The entire forefoot had gangrened with black skin. All five toes were amputated after debridement. (b) The appearance of the foot at 10 weeks after mTTT combined with antibiotic bone cement implantation and vacuum-assisted closure (VAC) drainage. Black crust was observed on the amputation wound. (c) The appearance of the foot at 16 weeks after mTTT. The wound had basically healed. D1 is the tibia X-ray image captured 1 day after the mTTT. D2–D3 are the tibial X-ray images captured at 2 and 6 weeks after the removal of the tibial outer frame. It was observed that the transport bone zone had basically healed with callus covering.