Igor Tudorache, Serghei Cebotari, Bettina Giere, Reinhard von Wasielewski, Jens Gottlieb, Andres Hilfiker, Axel Haverich; Hanover Medical School, Hanover, Germany
Objective: Tracheal replacement remains an unsolved problem in thoracic surgery, especially for patients with cancer lesions. Efforts to use tracheal substitutes have failed to achieve reliable results. In this study we present the results of thoracic trachea replacement with a novel autologous vascularized graft.Methods: Ten pigs underwent replacement of thoracic trachea (8cm) using a tubular graft based on autologous small bowel segment. Abdomen and thoracic time were performed in the same operative session. Intestinal lumen was sterilized by incubation with iodine solution. Eight fresh allogenic tracheal rings were fixed on the serosa by consecutive over-flapping of bowel wall. The blood circulation was restablished by the anastomosis of jejunal vascular pedicle with the right interernal thoracic artery and vein. No intraluminal T-tube or stents were used in postoperative period. Endoscopic examinations were performed in the first day and up to three month after the operation.
Results: All animals survived the operation without complication. No animals died because of air leakage, pneumonia or obstruction caused by bowel secretion. Graft necrosis (n=1) or concentric stenosis of proximal anastomosis (n=2) which did not respond to laser photoresection was the cause of postoperative death. The remaining animals were in good condition until they were euthanized. The bronchoscopy showed a normal mucosa and appropriate lumen. Histologigical examination revealed progressive metaplasy of intestinal mucosa, normal muscular layer and viable cartilage rings at three month.
Conclusion: Our reinforcement method of a free jejunal flap with allogenic tracheal rings, offer a viable graft for replacement of long tracheal defects which do not require additional intraluminal stabilisation or immunosuppresson.
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