title: Tracheal reconstruction by esophageal submuscular tunneling: an experimental study.
abstract: BACKGROUND
  The problem of how to treat large tracheal lesions remains a challenge in surgery. To reconstruct a long tracheal defect, a safe method other than end-to-end anastomosis is necessary.
  
  
  METHODS
  In 14 adult cross-breed dogs, a segment of trachea including seven tracheal rings was dissected and resected circumferentially. A submuscular tunnel was induced between mucosal and muscular layers of the adjacent esophagus lying right next to the trachea. An endotracheal tube was inserted between the tracheal rings 2 and 3. Then it was passed cautiously through the esophageal submuscular tunnel and through the distal tracheal segment. The proximal and distal ends of the esophageal tunnel and trachea were approximated and anastamosed. The animals were extubated 10 days after the operation.
  
  
  RESULTS
  All dogs tolerated the surgical procedure well. The first two dogs experienced postoperative fever, tracheoesophageal fistula, aspiration pneumonia, and sepsis so hard bony components were omitted from diet. All survived animals were eating and barking well. The submuscular esophageal tunnel was patent in all animals. The new lumen was supported externally with fibrous connective tissue. The tunnelized area was covered completely with pseudostratified ciliated epithelium.
  
  
  CONCLUSIONS
  Due to formation of fibrous tissue between skeletal muscular structures of the neck and the external layer of the tunnelized esophagus, the new airway remained patent. Overall, air tightness, good reepithelialization, and relatively no limitation of esophageal length are the advantages of tracheal reconstruction by submuscular esophageal tunneling. This new method is worthy of further investigation, as it is technically feasible and easy to implement.
authors.affiliation: Department of Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. jalah@sums.ac.ir
authors.forename: Hossein
authors.initials: H
authors.lastname: Hodjati
authors.forename: Kourosh
authors.initials: K
authors.lastname: Kazemi
authors.forename: Hamed
authors.initials: H
authors.lastname: Jalaeian
authors.forename: Hamid
authors.initials: H
authors.lastname: Reza Sharifzad
authors.forename: Naghmeh
authors.initials: N
authors.lastname: Roshan
authors.forename: Nader
authors.initials: N
authors.lastname: Tanideh
mesh_terms: D000818:Animals; D004285:Dogs; D004947:Esophagus / Q000601:surgery*; D009130:Muscle, Smooth / Q000601:surgery; D014132:Trachea / Q000601:surgery*