Polyglycolic acid/poly-L-lactic acid copolymer use in laryngotracheal reconstruction: a rabbit model.
OBJECTIVE
To evaluate the tissue response and resorption of the polyglycolic acid/poly-L-lactic acid (PGA/PLLA) implant in laryngotracheal reconstruction and compare its dynamic stability with autologous cartilage grafts.


METHODS
An interventional, before-after trial.


METHODS
Twenty-one white, female, New Zealand rabbits were divided into four groups. Groups A and B underwent laryngotracheoplasty using the PGA/PLLA implants of 3 and 4 mm widths. Group C received autologous ear cartilage grafts. Group D was the control group and did not undergo surgery. The subjects were sedated at 12 months, and the larynges were evaluated in vivo for stability and area measurements by way of endoscopy during spontaneous respiration. The subjects were then killed, the larynges harvested, and the negative intraluminal pressures applied to the laryngotracheal unit were measured in a closed-system apparatus. The larynges were then evaluated for inflammatory reaction and implant resorption by way of histologic analysis.


RESULTS
All implanted subjects survived without complications and grew normally. There was no appreciable subglottic collapse during spontaneous respiration under anesthesia. Ex vivo examination of maximum negative intraluminal pressures (-50 cm H2O) in a closed system demonstrated subglottic collapse of 78%, 72%, 61%, and 3% for groups A, B, C, and D, respectively, revealing the inherent weakness in the surgically manipulated airways regardless of grafting material. Histologically, the PGA/PLLA implants were essentially completely resorbed.


CONCLUSIONS
PGA/PLLA appears to be a safe and effective synthetic material for use in laryngotracheal reconstruction in the rabbit model while avoiding donor site morbidity and additional operative time. Reconstructed airways maintained adequate strength and patency under physiologic conditions and are comparable with autologous cartilage grafts.
Klein
Adam M
AM
Division of Otolaryngology, Head and Neck Surgery, The University of Connecticut Health Center, Farmington, Connecticut 06030, USA.
Graham
Vicki L
VL
Gulleth
Yusuf
Y
Lafreniere
Denis
D
D020341:Absorbable Implants; D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002356:Cartilage / Q000637:transplantation; D004195:Disease Models, Animal; D005260:Female; D005931:Glottis / Q000503:physiopathology; D007249:Inflammation; D019344:Lactic Acid / Q000627:therapeutic use*; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000601:surgery*; D011100:Polyglycolic Acid / Q000627:therapeutic use*; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011108:Polymers / Q000627:therapeutic use*; D011312:Pressure; D019736:Prostheses and Implants; D011817:Rabbits; D012119:Respiration; D012449:Safety; D013997:Time Factors; D014135:Tracheal Stenosis / Q000601:surgery*
D001672:Biocompatible Materials; D011108:Polymers; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid