title: Tracheal reconstruction: mucosal survival on porous titanium.
abstract: OBJECTIVE
  To investigate whether porous titanium can provide a better support for revascularization of a mucosal graft ideal for tracheal reconstruction. In patients with laryngotracheal stenosis or tumor, the mucosa with supporting structures can be damaged, resulting in a defect that has to be reconstructed. Autologous tissues like cartilage and mucosa have been used for reconstruction. The main problem has been incomplete mucosal reepithelialization.
  
  
  METHODS
  In the first experiment, porous titanium or ear cartilage was combined with mucosa and implanted subcutaneously in athymic mice for different periods of time. In the second experiment, using rabbits, surgically created defects were reconstructed with porous titanium and mucosa on a pedicled fascia flap using a 2-stage procedure. The implants were analyzed with emphasis on angiogenesis and mucosal survival.
  
  
  METHODS
  Male New Zealand white rabbits and nude athymic mice (BALB-c nu/nu).
  
  
  RESULTS
  Normal mucosa having a submucosal layer with vital cells was noted on top of the titanium. Multiple blood vessels were observed extending from the muscle layer through the titanium. Cytokeratin expression was detected in the suprabasal and basal layers of the mucosal epithelium. In contrast, the mucosa on cartilage showed no vital cells and no cytokeratin expression. In the rabbit experiment, all animals survived the reconstruction. The titanium was well integrated to the adjacent tracheal cartilage and surrounding tissues, supporting a fully vital mucosa.
  
  
  CONCLUSIONS
  Porous titanium is an inert biomaterial that provides support and allows easy revascularization of a mucosal graft. Titanium, in combination with viable autologous tissues, is a good alternative for tracheal reconstruction.
authors.affiliation: Department of Otorhinolaryngology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors.forename: Luuk M
authors.initials: LM
authors.lastname: Janssen
authors.forename: Gerjo J V M
authors.initials: GJ
authors.lastname: van Osch
authors.forename: Jia Ping
authors.initials: JP
authors.lastname: Li
authors.forename: Nicole
authors.initials: N
authors.lastname: Kops
authors.forename: Klaas
authors.initials: K
authors.lastname: de Groot
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Von den Hoff
authors.forename: Louw
authors.initials: L
authors.lastname: Feenstra
authors.forename: José A U
authors.initials: JA
authors.lastname: Hardillo
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D004425:Ear Cartilage; D006085:Graft Survival; D006801:Humans; D008297:Male; D051379:Mice; D011817:Rabbits; D019651:Plastic Surgery Procedures; D020545:Respiratory Mucosa / Q000098:blood supply*; D054457:Tissue Scaffolds; D014025:Titanium; D014132:Trachea / Q000601:surgery*
chemical_list: D001672:Biocompatible Materials; D014025:Titanium