title: Use of a revascularized, tubed costal myoperiosteal graft for repair of circumferential, segmental tracheal defects.
abstract: Reconstruction of extensive laryngotracheal stenosis continues to pose a significant surgical challenge. Previous work in our laboratory has demonstrated the utility of vascularized perichondrium for reconstruction of cervical tracheal defects in a rabbit model. Because most potential vascularized donor sites in human beings are periosteal, it was important to demonstrate that vascularized periosteum was also useful for laryngotracheal reconstruction in a larger animal model. We therefore performed a 2-stage reconstruction of a circumferential, segmental cervical tracheal defect using a revascularized, tubed myoperiosteal graft in a canine model (n = 8). A rigid, patent tube was produced in 6 animals (75%) after completion of the first stage (7 to 10 weeks). After transfer of the vascularized free graft to the tracheal defect, 5 of 6 animals survived from 4 to 18 weeks. Severe stenosis (>90%) was present in 2 animals, and moderate stenosis (40% to 60%) was present in the remaining 3 animals. One animal was observed for 18 weeks and was found to have a 40% circumferential stenosis at autopsy. Light microscopy revealed exuberant bone proliferation in all specimens. Unrestrained osteogenesis may limit the utility of vascularized periosteum in reconstruction of extensive tracheal defects.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, USA.
authors.forename: P T
authors.initials: PT
authors.lastname: Hoff
authors.forename: R M
authors.initials: RM
authors.lastname: Esclamado
mesh_terms: D000403:Airway Resistance; D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D006801:Humans; D007366:Intercostal Muscles / Q000098:blood supply / Q000254:growth & development / Q000637:transplantation*; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D024510:Muscle Development; D010012:Osteogenesis / Q000502:physiology; D010521:Periosteum / Q000098:blood supply / Q000254:growth & development / Q000637:transplantation*; D011817:Rabbits; D013524:Surgical Flaps; D014135:Tracheal Stenosis / Q000601:surgery*