Prefabrication of composite grafts for long-segment tracheal reconstruction.
OBJECTIVE
To investigate the prefabrication of vascularized mucosa-lined composite grafts intended to replace circumferential tracheal defects.


METHODS
Plane grafts composed of ear cartilage and full-thickness oral mucosa were revascularized by the laterothoracic fascia. The use of meshed vs nonmeshed mucosa to improve the epithelial coverage was examined. We also investigated the creation of a vascular bed over the cartilage and the subsequent application of meshed mucosa. Macroscopic aspects, viability, and degree of mucosal lining were analyzed.


METHODS
Twenty male New Zealand white rabbits.


METHODS
Ten animals underwent placement of auricular cartilage under the laterothoracic fascia. Intact (group 1) or meshed mucosa (group 2) was applied over the fascia and protected by a silicone sheet. After 3 weeks, prefabricated grafts were removed for comparison. In 10 other animals, a sheet of perforated cartilage was placed under the laterothoracic fascia. Two weeks later, 5 grafts (group 3) were harvested. The remaining 5 grafts were reopened for mucosal application over the cartilage and revascularized for 3 additional weeks (group 4).


RESULTS
Vascularized plane grafts were obtained in all groups. Mucosal lining increased significantly with meshed mucosa (14%-68%; mean, 40%) compared with nonmeshed mucosa (3%-15%; mean, 10%) (P = .008). Induction of a vascular bed over perforated cartilage was achieved, but survival of secondary implanted mucosa was variable.


CONCLUSIONS
A reliable technique to prefabricate composite grafts with cartilaginous support and mucosal lining is presented. The use of meshed mucosa significantly improves epithelial coverage.
Jaquet
Yves
Y
Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland. yves.jacquet@hospvd.ch
Pilloud
Raphaelle
R
Lang
Florian J W
FJ
Monnier
Philippe
P
D000818:Animals; D004425:Ear Cartilage / Q000637:transplantation*; D005205:Fascia / Q000637:transplantation*; D006085:Graft Survival; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D018919:Neovascularization, Physiologic; D011817:Rabbits; D013526:Surgical Mesh; D019738:Surgically-Created Structures; D014132:Trachea / Q000601:surgery; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic; D019737:Transplants