THE LIMB SAVERS@JURONGHEALTH
Care Process & Redesign
National Healthcare Innovation and Productivity Medals
National University Health System
3 December 2025
To introduce and implement the Transverse Tibial Transport (TTT) technique at Ng Teng Fong General Hospital (NTFGH) to. TTT has demonstrated remarkable success since its implementation, achieving a 100% limb salvage success rate and beginning to spread.
Year Submitted: 2025
Published Date: 03 December 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Workflow Redesign, Clinical Practice Improvement, Functional Outcome, Risk Management, Preventive Approach
About this Content
Aims
To introduce and implement the Transverse Tibial Transport (TTT) technique at Ng Teng Fong General Hospital (NTFGH) to reduce major amputations and preserve limbs in severe diabetic foot ulcer cases.
Background
Singapore faces one of the highest age-sex-adjusted rates of diabetes-related lower extremity amputations (LEAs) globally. The prevalence of diabetes in Singapore is escalating, with an estimated 660,000 diabetes patients 18 years old by 2030. 25% of patients are at risk of developing diabetic foot ulcers (DFUs), which have a 20 times higher risk of LEAs.
Methods
Develop planning strategy to implement TTT technique at NTFGH, develop multidisciplinary team approach, establish patient selection criteria and treatment protocols, procure and obtain regulatory approval for specialised External Fixation System from Health Sciences Authority (HSA) of Singapore.
Results
From May to December 2024, all 11 patients facing imminent LEA were successfully treated, achieving a 100% limb salvage success rate. The technique has spread, with a total of 24 cases treated in Singapore, and Woodlands Health and Changi General Hospital adopting the technique for 4 and 2 cases, respectively.
Conclusion
TTT has demonstrated remarkable success since its implementation, achieving a 100% limb salvage success rate and beginning to spread to other hospitals.
Lessons Learnt
Multidisciplinary collaboration is crucial for successful implementation of complex innovative techniques like TTT. Innovative surgical approaches can dramatically improve outcomes in cases previously considered untreatable. Looking beyond traditional Western medical practices can yield valuable solutions.
The technique's origins in Chinese medicine highlight Singapore's unique position bridging Eastern and Western medical traditions, offering opportunities for further innovation
Additional Information
National Healthcare Innovation & Productivity Medals Award 2025: Best Practice Medal (Care Redesign)
Keywords
Quality Improvement, Workflow Redesign, Clinical Practice Improvement, Functional Outcome, Preventive Approach
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | Ng Teng Fong General Hospital |
Platform(s) | National Healthcare Innovation and Productivity Medals |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Surgery |
Project Lead(s) | CHEN YONGSHENG |
Project Member(s) | NG SOW CHUN |
Connect with this contributor!
CHEN YONGSHENG - yongsheng_chen@nuhs.edu.sg