Monday Afternoon, April 17, 1950

2:00 P.M. Executive Session.

3:00 P.M. Scientific Session.

Address of the President-Edward J. O'Brien, M.D., Detroit, Mich.

17. The Experimental Use of Homogenous Tracheal Transplants.

Truxton D. Jackson, M.D. (by invitation)

Edward J. O'Brien, M.D., William Tuttle, M.D. and

John Meyer, M.D. (by invitation), Detroit, Mich.

The experiments consisted of transplanting homogenous tracheal sections, using mature dogs as the experimental animals. Varying sized tracheal and bronchial defects were created surgically and these were covered with homogenous transplants. Entire cylinders of the trachea up to four centimeters in length were removed and the defects successfully bridged with transplants.

After the transplants were obtained, they were either inserted immediately or preserved and used at any time up to two weeks thereafter.

The transplants were studied after sacrifice of the animals. Autopsies were performed from two and one-half weeks to eleven months after surgery.

A surgical technic for securing the transplants in place is described.

18. Resection of the Trachea and Bronchi-an Experimental Study.

Max G. Carter, M.D., (by invitation), New Haven, Conn,

and John W. Strieder, M.D., Brookline, Mass.

The problems involved in the repair of defects in the trachea and bronchi are stated and the criteria for a physiologically satisfactory reconstruction are catalogued. Previous efforts for the repair of tracheo-bronchial defects following radical resection of segments are briefly reviewed.

A series of 20 animal experiments have been performed to develop a method of radical bronchial resection and repair. A method was developed for the insertion of an inlying endotracheal tube at operation to maintain an airway to the remaining pulmonary tissue and to facilitate the leisurely repair of tracheal and bronchial defects.

Autografts with segments of bronchus from resected lobes or lungs proved to possess the correct characteristics for a satisfactory postoperative recovery and healed without developing fibrous stenosis.

Homografts of complete tracheal segments from donor animals functioned well through the immediate postoperative period but resulted in gradual resorption and the late development of fibrous stenosis at the site of repair.

The operative technics are pictorially described.

19. Further Experiences With Dermal Grafts for Healed Tuberculous Stenosis of the Bronchi and Trachea.

Paul W. Gebauer, M.D., Honolulu, Hawaii

Of 136 patients with tuberculous tracheobronchitis 20 died, 27 are still receiving sanatorium treatment, and 26 have been discharged as healed. The remaining 63 (46%) have received surgical treatment. Of these, 13 patients had successful thoracoplasties. In 22 patients severe main bronchial stenosis plus distal lung destruction required pneumonectomy, three of these having had previous thoracoplasties. In five patients the bronchial lesion healed without the production of significant stenosis, but pneumonectomy was done for extensive lung disease unsuitable for collapse. Ten patients developed stenoses that required lobectomy, bi-lobectomy or segmental resection. In two patients pneumonectomy was avoided by reconstruction, with dermal grafts, of severely stenosed main bronchi, the parenchymal disease having healed. Pneumonectomy was avoided in eight patients by the substitution of lobectomy and dermal graft to the main bronchial stenosis. Three patients died from surgical attempts to correct severe, co-existent but separate, stenoses of both the trachea and the right main bronchus. These are the only deaths in the surgical series.

This experience supports the obvious facts that excisional surgery usually is indicated in bronchial stenosis, and that successful collapse occasionally can be applied despite some bronchial deformity. On the other hand, it shows that there are a significant number of patients in whom a direct surgical attack on the bronchial lesion itself is indicated. Wire-enforced dermal grafts provide a good surgical method of lessening the extent of necessary resection, or avoiding it entirely when the parenchymal disease is minimal or healed. The clinical and surgical criteria and indications for their use are illustrated by case reports.