Replacement of a tracheal defect with a tissue-engineered prosthesis: early results from animal experiments.
OBJECTIVE
The major problems in the development of tracheal prosthesis are anastomotic dehiscence and stenosis, caused by poor epithelialization of the prosthetic graft. We developed a novel tracheal prosthesis with viable mucosa transplanted from the oral cavity and reported excellent long-term results after thoracic tracheal replacements in dogs. In the current study, we used tissue-engineering techniques to construct a mucosal prosthetic lining from skin cells and evaluated its usefulness in tracheal replacement.


METHODS
Abdominal skin patches (5 x 10 cm) were harvested from 10 adult mongrel dogs. The epithelial cells were separated, cultured in vitro for 4 weeks, and then seeded onto a porous polylactic glycolic acid scaffold (6 x 8 cm) to construct a lining mucosa. This was then mounted onto the prosthesis framework, made with polypropylene mesh reinforced with polypropylene rings. The mucosa-lined prosthesis was wrapped with the greater omentum of the same dog and placed in the peritoneal cavity for 1 week. Complete surgical resection and replacement of a thoracic tracheal segment (5 cm in length, just above the carina) was then performed using the prosthesis.


RESULTS
The animals regained full activity and survived with normal activity. Bronchoscopy at 1 week and at 1 and 2 months revealed no stenosis in the anastomosis.


CONCLUSIONS
This highly biocompatible tracheal prosthesis could prove useful for the reconstruction of large, circumferential tracheal defects.
Kim
Jhingook
J
Department of Thoracic Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea. jkim@smc.samsung.co.kr
Suh
Soo Won
SW
Shin
Ji Yeon
JY
Kim
Jin Hoon
JH
Choi
Yong Soo
YS
Kim
Hojoong
H
D000714:Anastomosis, Surgical; D000818:Animals; D001999:Bronchoscopy; D004195:Disease Models, Animal; D004285:Dogs; D005336:Fiber Optic Technology; D008955:Models, Cardiovascular; D009061:Mouth Mucosa / Q000637:transplantation; D009852:Omentum / Q000637:transplantation; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D012720:Severity of Illness Index; D013997:Time Factors; D023822:Tissue Engineering; D014132:Trachea / Q000473:pathology* / Q000601:surgery*