{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:47:04Z","timestamp":1792291624737,"version":"4.4.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Chronic limb\u2010threatening ischemia (CLTI) compounded by diabetic foot ulceration remains a leading precursor to major lower\u2010extremity amputation. Transverse tibial transport (TTT) can improve perfusion but requires corticotomy and bulky external fixation. We report what is, to our knowledge, the first application of fully automated tibial periosteal distraction (PD) for limb preservation. A 65\u2010year\u2010old man with recurrent forefoot gangrene underwent tibial PD using a miniaturised, programmable motor to gradually elevate the periosteum. Through a 1\u2009cm incision, a low\u2010profile subperiosteal plate was implanted and linked to the motor, which advanced 0.031\u2009mm hourly (0.75\u2009mm\/day) up to 10\u2009mm. Distraction was completed uneventfully over 13\u2009days, and the device was removed at the bedside on Day 21. Skin temperature increased by 2\u00b0C, and digital systolic (toe) pressure rose from 22 to 50\u2009mmHg. The wound progressed to healing without complication. Automated PD may offer a minimally invasive, biologically driven alternative for high\u2010risk CLTI patients, eliminating the need for patient\u2010adjusted screws and standardising adherence. Prospective studies are required to validate its safety, durability, optimal distraction parameters and cost\u2010effectiveness.<\/jats:p>","DOI":"10.1111\/iwj.70824","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:55:22Z","timestamp":1767855322000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Automated Periosteal Distraction for Limb Salvage in Diabetic Foot Ulcers With Chronic Limb\u2010Threatening Ischemia (Brief Communication)"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8337-8505","authenticated-orcid":false,"given":"Lucian M.","family":"Feraru","sequence":"first","affiliation":[{"name":"Department of Podiatric Surgery Adventist Health White Memorial  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6658-9482","authenticated-orcid":false,"given":"Tze Woei","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Surgery Keck School of Medicine at the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1887-9175","authenticated-orcid":false,"given":"David G.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Surgery Keck School of Medicine at the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70724"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047-020-00383-2"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.10578"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.08.003"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.70124"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2024.2404186"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.11.057"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000041183"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2024.1396897"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.12307\/2022.910"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.70824","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.70824","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.70824","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:15:10Z","timestamp":1773011710000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.70824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/iwj.70824"],"URL":"https:\/\/doi.org\/10.1111\/iwj.70824","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-10-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70824"}}