title: Composite cervical skin and cartilage flap provides a novel large airway substitute after long-segment tracheal resection.
abstract: OBJECTIVE
  Airway replacement after long-segment tracheal resection for benign and malignant disease remains a challenging problem because of the lack of a substitute conduit. Ideally, an airway substitute should be well vascularized, rigid, and autologous to avoid infections, airway stenosis, and the need for immunosuppression. We report the development of an autologous tracheal substitute for long-segment tracheal resection that satisfies these criteria and demonstrates excellent short-term functional results in a large-animal study.
  
  
  METHODS
  Twelve adult pigs underwent long-segment (6 cm, 60% of total length) tracheal resection. Autologous costal cartilage strips measuring 6 cm x 2 mm were harvested from the chest wall and inserted at regular 0.5-cm intervals between dermal layers of a cervical skin flap. The neotrachea was then scaffolded by rotating the composite cartilage skin flap around a silicone stent measuring 6 cm in length and 1.4 cm in diameter. The neotrachea replaced the long segment of tracheal resection, and the donor flap site was closed with a double-Z plasty. Animals were killed at 1 week (group I, n = 4), 2 weeks (group II, n = 4), and 5 weeks (group III, n = 4). In group III the stent was removed 1 week before death. Viability of the neotrachea was monitored by means of daily flexible bronchoscopy and histologic examination at autopsy. Long-term morbidity and mortality were determined by monitoring weight gain, respiratory distress, and survival.
  
  
  RESULTS
  There was no mortality during the study period. Weight gain was appropriate in all animals. Daily bronchoscopy and postmortem histologic evaluation confirmed excellent viability of the neotrachea. There was no evidence of suture-line dehiscence. Five animals had distal granulomas that were removed by using rigid bronchoscopy. In group III 1 animal had tracheomalacia, which was successfully managed by means of insertion of a silicon stent.
  
  
  CONCLUSIONS
  Airway reconstruction with autologous cervical skin flaps scaffolded with costal cartilages is a novel approach to replace long segments of resected trachea. This preliminary study demonstrates excellent respiratory function and survival in large animals undergoing resection of more than 50% of their native trachea. Use of cervical skin flaps buttressed with costal cartilage is a promising solution for long-segment tracheal replacement.
authors: Laboratoire de Chirurgie Experimentale, Hôpital Marie-Lannelongue, Le Plessis Robinson, France. d.fabre@ccml.fr
authors: Dominique
authors: D
authors: Fabre
authors: Sunil
authors: S
authors: Singhal
authors: Vincent
authors: V
authors: De Montpreville
authors: Benoit
authors: B
authors: Decante
authors: Sacha
authors: S
authors: Mussot
authors: Olivier
authors: O
authors: Chataigner
authors: Olaf
authors: O
authors: Mercier
authors: Frederic
authors: F
authors: Kolb
authors: Philippe G
authors: PG
authors: Dartevelle
authors: Elie
authors: E
authors: Fadel
mesh_terms: D000818:Animals; D001980:Bronchi; D002356:Cartilage / Q000637:transplantation*; D008297:Male; D009333:Neck; D019651:Plastic Surgery Procedures / Q000379:methods*; D012272:Ribs; D016038:Skin Transplantation; D015607:Stents / Q000009:adverse effects; D013524:Surgical Flaps; D034421:Sus scrofa; D014132:Trachea / Q000601:surgery*; D014182:Transplantation, Autologous