Abstract / Summary
Tibial cortex transverse transport (TTT) based on Ilizarov’s tension–stress principle promotes angiogenesis and repair in ischemic limbs, but is impractical in patients with severe tibial infection or absent tibial segments. We established a femoral cortex transverse transport (FTT) model to test whether transverse distraction at an alternative skeletal site could engage similar biological outputs of TTT. Thirty-six male Sprague–Dawley rats were randomized to control, sham, or FTT groups ( n = 12/group). After femoral corticotomy and external fixation, bidirectional transport was performed. Wound healing and mechanistic readouts were assessed by micro-CT-based vascular analysis, superb microvascular imaging, histology, immunofluorescence, and ELISA. FTT significantly accelerated cutaneous wound closure compared with sham and control (day 15, p < 0.001), with improved re-epithelialization, increased dermal thickness, and better collagen organization. Vascular perfusion imaging demonstrated greater microvascular volume and enhanced distal limb blood flow, accompanied by increased CD31 and α-SMA expression in regenerating skin, indicating augmented neovascularization and vessel maturation. Systemically, FTT elevated circulating HIF-1α, IGF-1, OPG, and LCN2, and promoted macrophage polarization toward a reparative M2-like phenotype. In conclusion, FTT engages overlapping but femur-specific systemic signaling, yielding comparable regenerative outcomes via a femur-based mechanobiological route and supporting FTT as a feasible alternative approach to enhance microcirculatory recovery and wound healing when tibial-based transport is contraindicated.