Transplantation of tracheal autografts: is a two-stage procedure necessary?
BACKGROUND
Tracheal autotransplantation has been shown to be a reliable technique for repairing the hemilaryngectomy defect that includes the hemicricoid cartilage and results from resection of unilateral laryngeal cancer with significant subglottic extension. The technique involves a two-stage procedure of cervical tracheal revascularization by wrapping the trachea in a vascularized radial forearm flap and subsequent tracheal transplantation on a newly created vascular pedicle consisting of the radial artery and vein (1, 2).


OBJECTIVE
To experimentally (rabbits) investigate if a one-stage tracheal revascularization and transplantation procedure could be a viable option.


METHODS
Tracheal patch autografts (1.5 cm x 1 cm) were excised and reimplanted at the anterior cervical trachea with four different patterns of vascular supply: group I: tracheal patch wrapped with vascularized fascia 14 days before excision of the patch (two-stage procedure); group II: tracheal patch wrapped with vascularized fascia at the time of patch excision; group III: tracheal patch without tissue wrapping; and group IV: tracheal patch wrapped with a sheet of Gore-Tex after reimplantation. After orthotopical reimplantation, the patches showed decreasing vascular contacts from group I to group IV. The patches were evaluated morphologically at the moment the animal became dyspnoeic or two weeks after reimplantation in asymptomatic animals.


RESULTS
Group I patches fully preserved their viability (median percentage mucosal viability of 100%). Autografts in group II and III showed varying degrees of necrosis and graft take with a median percentage graft viability of 59 and 69% respectively. All group IV tracheal patches showed full thickness necrosis over the majority of their surface area (median percentage graft viability of 10%).


CONCLUSIONS
Fascia enwrapped tracheal autografts show reliable revascularization through the intercartilaginous ligaments only when a 2 stage revascularization technique is used.
Hardillo
J A
JA
Department of Oto-Rhino-Laryngology Head and Neck Surgery, University Hospitals of Leuven.
Vander Poorten
V
V
Delaere
P R
PR
D000818:Animals; D003413:Cricoid Cartilage / Q000601:surgery; D004417:Dyspnea / Q000209:etiology; D005205:Fascia / Q000637:transplantation; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006085:Graft Survival; D007825:Laryngectomy / Q000534:rehabilitation; D008567:Membranes, Artificial; D009336:Necrosis; D018919:Neovascularization, Physiologic; D011138:Polytetrafluoroethylene; D011817:Rabbits; D012092:Replantation; D015203:Reproducibility of Results; D012119:Respiration; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology; D015996:Survival Rate; D014132:Trachea / Q000098:blood supply / Q000637:transplantation*; D014182:Transplantation, Autologous / Q000379:methods
D008567:Membranes, Artificial; D011138:Polytetrafluoroethylene