title: Replacement of the esophagus with fascial flap-wrapped allogenic aorta.
abstract: BACKGROUND
  Segmental replacement of the esophagus (SRE) is challenging. Allogenic aorta (AA) has shown promising remodeling abilities when used as an esophageal substitute. The aim of this study was to evaluate the feasibility and results of esophageal replacement with fascial flap-wrapped AA segments in a novel rabbit model.
  
  
  METHODS
  Seven Geant des Flandres rabbits and one New Zealand rabbit served as thoracic aorta donors, and 25 New Zealand rabbits were used as recipients. One to 3 wk before esophageal replacement either cryopreserved or fresh thoracic aortic segments were wrapped in thoracic wall fascia to generate revascularization. In an attempt to optimize the model, step-by-step modifications concerning perioperative and postoperative management of the recipients were made as results accumulated. Microscopic evaluation was focused on the viability of aortic segments and neoangiogenesis originating from the fascia.
  
  
  RESULTS
  Survival after SRE was poor. Most recipients died within 1 wk, mainly from upper digestive tract hypomotility. Microscopically, AAs were severely necrosed. In one recipient sacrificed on day 16, the edges of the graft became evanescent. In these areas, esophageal reepithelialization directly covered the fascia, in which unexpected smooth muscle cells were found, suggestive of the first stages of esophageal remodeling of the graft.
  
  
  CONCLUSIONS
  Results for SRE using fascial-wrapped AAs in rabbits were disappointing. The transposition of this approach to larger animals might result in longer survival, increasing the possibility for more complete graft remodeling.
authors.affiliation: Inserm UMR 837, Lille University Medical School, UDSL, University Lille Nord de France, Lille, France; Department of Digestive and Oncological Surgery, Lille University Teaching Hospital, CHULille, Lille, France.
authors.forename: Williams
authors.initials: W
authors.lastname: Tessier
authors.affiliation: Inserm UMR 837, Lille University Medical School, UDSL, University Lille Nord de France, Lille, France; Department of Digestive and Oncological Surgery, Lille University Teaching Hospital, CHULille, Lille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
authors.affiliation: Institute of Pathology, Lille University Teaching Hospital, CHULille, Lille, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Copin
authors.affiliation: Department of Digestive and Oncological Surgery, Lille University Teaching Hospital, CHULille, Lille, France.
authors.forename: William B
authors.initials: WB
authors.lastname: Robb
authors.affiliation: European Homograft Bank, Brussels, Belgium.
authors.forename: Ramadan
authors.initials: R
authors.lastname: Jashari
authors.affiliation: IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, University Lille Nord de France, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hubert
authors.affiliation: IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, University Lille Nord de France, Lille, France; Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHULille, Lille, France. Electronic address: alain.wurtz@chru-lille.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Wurtz
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D019072:Antibiotic Prophylaxis; D001013:Aorta, Thoracic / Q000637:transplantation*; D049628:Body Size; D015154:Esophageal Motility Disorders / Q000209:etiology / Q000401:mortality*; D004947:Esophagus / Q000601:surgery*; D005205:Fascia / Q000637:transplantation*; D005240:Feasibility Studies; D005260:Female; D008297:Male; D023421:Models, Animal; D011817:Rabbits; D012828:Silicones; D015607:Stents; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality*
chemical_list: D012828:Silicones
keywords: Allogenic aorta; Animal model; Esophageal replacement; Esophagus