Dynamic tissue distraction may enhance therapeutic efficacy for Critical limb ischemia

Critical limb ischemia (CLI) is the most serious stage of lower limb arterial disease, often presenting as severe ischemic resting pain, ulcer or tissue gangrene. The treatments for CLI pose a medical challenge. Despite the various treatments available for CLI, there is still no treatment that is entirely effective and acceptable to all patients. Patients with CLI are often elderly and have complex medical conditions, multiple comorbidities, and limited surgical tolerance. Among CLIs, patients with Transatlantic Inter-Society Consensus (TASC) grade D typically exhibit long-segmental and diffuse vascular lesions in their lower extremity arteries, often accompanied by microvascular lesions. It is obviously difficult to reopen multiple extensive segmental vessels with open bypass surgery or endovascular treatment within the limited surgical time, and such methods are ineffective in improving microcirculation. As emerging techniques for lower limb microcirculation reconstruction, tibial cortex transverse distraction and periosteal distraction are both forms of distraction histogenesis (DH) technology, their efficacy in treating CLI is verified, yet their associated treatment parameters still have potential for optimization. Existing biomechanical researches suggest that dynamic stretching may yield superior biological outcomes compared to static stretching, we hypothesize that employing dynamic stretching in tissue distraction techniques may yield a better therapeutic effect, thereby enhancing the efficacy of DH techniques for CLI and reducing the associated complications.