title: Successful tracheal replacement in humans using autologous tissues: an 8-year experience.
abstract: BACKGROUND
  Fifty years of surgical research using synthetic materials and heterologous tissues failed to find a good, durable replacement for the trachea. We investigated autologous tracheal substitution (ATS) without synthetic material or immunosuppression.
  
  
  METHODS
  For ATS, we used a single-stage operation to construct a tube from a forearm free fasciocutaneous flap vascularized by radial vessels that was reanastomosed to internal mammary vessels and reinforced by rib cartilages interposed transversally in the subcutaneous tissue. Tracheal resections 7 to 12 cm long (mean, 11 cm) were done to treat 8 primary tracheal neoplasms, including 5 adenoid cystic carcinomas (ACC) and 3 squamous cell carcinomas (SCC); 3 secondary tracheal neoplasms, including 1 thyroid carcinomas and 2 lymphomas; and 1 postintubation tracheal destruction after a long history of stenting. Transitory tracheotomy was associated to the absence of mucociliary clearance.
  
  
  RESULTS
  ATS has been performed in 12 patients since 2004, with additional resections in 4 patients, comprising 1 carinal resection alone, 1 associated with lobectomy, and 2 pharyngolaryngectomies. All patients were extubated on postoperative day 1. Eight patients are alive at a mean of 36 months (range, 2 to 94 months) postoperatively, with no respiratory distress. The 2 patients with ATS and carinal resections died of pulmonary infection. No airway collapse has been detected by endoscopy, dynamic computed tomography scan, or spirometry. Two patients still have a tracheotomy because the procedure was performed too low at the level of the proximal anastomosis. One patient with a chronic severe respiratory insufficiency recently required a distal, short stent.
  
  
  CONCLUSIONS
  ATS is a good, durable, tracheal substitution that resists respiratory pressure variations because of transverse rigidity, without any immunosuppression.
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France. Electronic address: d.fabre@ccml.fr.
authors.forename: Dominique
authors.initials: D
authors.lastname: Fabre
authors.affiliation: Thoracic Oncology Institute, Institut Gustave Roussy, Villejuif, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Kolb
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Sacha
authors.initials: S
authors.lastname: Mussot
authors.affiliation: Thoracic Oncology Institute, Institut Gustave Roussy, Villejuif, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Chevalier
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dartevelle
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D014132:Trachea / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000601:surgery*; D014182:Transplantation, Autologous
keywords: 15