TRACHEA REPAIR AND RECONSTRUCTION WITH NEW COMPOSITE ARTIFICIAL TRACHEA TRANSPLANTATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Wenliang ¹ , XIAO Peng ² , LIANG Hengxing ¹ , AN Ran ¹ , CHENG Gang ¹ , YU Fenglei ¹

1Department of Thoracic Surgery, Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P.R.China;;
2Department of Thoracic Surgery, Third Xiangya Hospital, Central South University. Corresponding author: YU Fenglei, E-mail: Yufl8@yahoo.com. cn;

Corresponding author：

Keywords：

Artificial trachea; Trachea repair and reconstruction; Dog

DOI：

10.7507/1002-1892.20130076

Video：

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Objective To construct a new composite artificial trachea and to investigate the feasibility of trachea repair and reconstruction with the new composite artificial trachea transplantation in dogs. Methods The basic skeleton of the new composite artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings at both ends. Dualmesh was sutured on titanium rings. Sixteen dogs, weighing (14.9 ± 2.0) kg, female or male, were selected. The 5 cm cervical trachea was resected to prepare the cervical trachea defect model. The trachea repair and reconstruction was performed with the new composite artificial trachea. Then fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction were conducted at immediate, 1 month, and 6 months after operation. Gross observation and histological examination were conducted at 14 months to evaluate the repair and reconstruction efficacy. Results No dog died during operation of trachea reconstruction. One dog died of dyspnea at 37, 41, 55, 66, 140, and 274 days respectively because of anastomotic dehiscence and artificial trachea displacement; the other 10 dogs survived until 14 months. The fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction showed that artificial tracheas were all in good location without twisting at immediate after operation; mild stenosis occurred and anastomoses had slight granulation in 6 dogs at 1 month; severe stenosis developed and anastomosis had more granulation in 1 dog and the other dogs were well alive without anastomotic stenosis at 6 months. At 14 months, gross observation revealed that outer surface of the artificial trachea were encapsulated by fibrous connective tissue in all of 10 dogs. Histological examination showed inflammatory infiltration and hyperplasia of fibrous tissue and no epithelium growth on the inner wall of the artificial trachea. Conclusion The new composite artificial trachea can be used to repair and reconstruct defect of the trachea for a short-term. Anastomotic infection and dehiscence are major complications and problems affecting long survival.

Citation： LIU Wenliang,XIAO Peng,LIANG Hengxing,AN Ran,CHENG Gang,YU Fenglei. TRACHEA REPAIR AND RECONSTRUCTION WITH NEW COMPOSITE ARTIFICIAL TRACHEA TRANSPLANTATION. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(3): 330-334. doi: 10.7507/1002-1892.20130076 Copy

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2.	Asnaghi A, Macchiarini P, Mantero S. Tissue engineering toward organ replacement: a promising approach in airway transplant. Int J Artif Organs, 2009, 32(11): 763-768.
3.	Sato T, Tao H, Araki M, et al. Replacement of the left main bronchus with a tissue-engineered prosthesis in a canine model. Ann Thorac Surg, 2008, 86(2): 422-428.
4.	Choi HS, Suh H, Lee JH, et al. A polyethylene glycol grafted bi-layered polyurethane scaffold: preliminary study of a new candidate prosthesis for repair of a partial tracheal defect. Eur Arch Otorhinolaryngol, 2008, 265(7): 809-816.
5.	史宏灿, 徐志飞, 秦雄. 高分子聚合物材料人工气管移植的实验研究. 中华外科杂志, 2004, 42(16): 972-975.
6.	Wu W, Cheng X, Zhao Y, et al. Tissue engineering of trachea-like cartilage grafts by using chondrocyte macroaggregate: experimental study in rabbits. Artif Organs, 2007, 31(11): 826-834.
7.	Yamashita M, Kanemaru S, Hirano S, et al. Tracheal regeneration after partial resection: a tissue engineering approach. Laryngoscope, 2007, 117(3): 497-502.
8.	Seguin A, Martinod E, Kambouchner M, et al. Carinal replacementwith an aortic allograft. Ann Thorac Surg, 2006, 81(3): 1068-1074.
9.	王嵩, 史宏灿. 人工气管研究进展. 中国修复重建外科杂志, 2011, 25(3): 365- 368.
10.	刘军, 石文君, 张苏宁. 肺组织瓣包埋金属支架重建气管、食管的动物实验研究. 中华医学杂志, 2011, 91(1): 65-68.
11.	赵俊刚, 张苏宁, 石文君, 等. 自体肺组织瓣内衬记忆合金支架替代长节段气管缺损: 动物实验及临床观察. 中国组织工程研究与临床康复, 2008, 12(22): 4209-4212.
12.	纪子钊, 陈刚, 张苏宁, 等. 记忆合金材料弹力金属支架在犬肺组织瓣重建气管缺损中的应用. 中国组织工程研究与临床康复, 2011, 15(51): 9549-9552.
13.	曹子昂, 顾旭东, 林海平, 等. 自体心包包裹人工气管修复气管缺损的组织相容性评估. 中国组织工程研究与临床康复, 2008, 12(14): 2645-2647.
14.	张银合, 赵凤瑞, 刘德若, 等. 记忆合金网二期成形人工气管实验研究. 中华胸心血管外科杂志, 2004, 20(2): 67-69.
15.	Jorge RG, Armengod AC, Caravajal JM. As originally published in 1990: Experimental study of a new porous tracheal prosthesis. Updated in 1998. Ann Thorac Surg, 1998, 65(6): 1830-1831.
16.	Schultz P, Vautier D, Charpiot A, et al. Development of tracheal prostheses made of porous titanium: a study on sheep. Eur Arch Otorhinolaryngol, 2007, 264(4): 433-438.
17.	Dupret-Bories A, Schultz P, Vrana NE, et al. Development of surgical protocol for implantation of tracheal prostheses in sheep. J Rehabil Res Dev, 2011, 48(7): 851-864.
18.	Tan A, Cheng S, Cui P, et al. Experimental study on an airway prosthesis made of a new metastable β-type titanium alloy. J Thorac Cardiovasc Surg, 2011, 141(4): 888-894.
19.	Park CH. Histological study of expanded polytetrafluoroethylene (Gore-Tex) implanted in the human nose. Rhinology, 2008, 46(4): 317-323.
20.	李东, 陈东明, 李生, 等. 国产膨体聚四氟乙烯植入大鼠皮下后的相关组织学变化. 中华医学美学美容杂志, 2005, 11(6): 351-354．.
21.	Conrad K, Torgerson CS, Gillman GS. Applications of Gore-Tex implants in rhinoplasty reexamined after 17 years. Arch Facial Plast Surg, 2008, 10(4): 224-231.
22.	李文芳, 章杰. 生物材料与鼻整形修复: 作用与地位的可靠性. 中国组织工程研究与临床康复, 2009, 13(34): 6761-6764.
23.	Delaere PR. Tracheal transplantation. Curr Opin Pulm Med, 2012, 18(4): 313-320.

1. Fishman JM, De Coppi P, Elliott MJ, et al. Airway tissue engineering. Expert Opin Biol Ther, 2011, 11(12): 1623-1635.
2. Asnaghi A, Macchiarini P, Mantero S. Tissue engineering toward organ replacement: a promising approach in airway transplant. Int J Artif Organs, 2009, 32(11): 763-768.
3. Sato T, Tao H, Araki M, et al. Replacement of the left main bronchus with a tissue-engineered prosthesis in a canine model. Ann Thorac Surg, 2008, 86(2): 422-428.
4. Choi HS, Suh H, Lee JH, et al. A polyethylene glycol grafted bi-layered polyurethane scaffold: preliminary study of a new candidate prosthesis for repair of a partial tracheal defect. Eur Arch Otorhinolaryngol, 2008, 265(7): 809-816.
5. 史宏灿, 徐志飞, 秦雄. 高分子聚合物材料人工气管移植的实验研究. 中华外科杂志, 2004, 42(16): 972-975.
6. Wu W, Cheng X, Zhao Y, et al. Tissue engineering of trachea-like cartilage grafts by using chondrocyte macroaggregate: experimental study in rabbits. Artif Organs, 2007, 31(11): 826-834.
7. Yamashita M, Kanemaru S, Hirano S, et al. Tracheal regeneration after partial resection: a tissue engineering approach. Laryngoscope, 2007, 117(3): 497-502.
8. Seguin A, Martinod E, Kambouchner M, et al. Carinal replacementwith an aortic allograft. Ann Thorac Surg, 2006, 81(3): 1068-1074.
9. 王嵩, 史宏灿. 人工气管研究进展. 中国修复重建外科杂志, 2011, 25(3): 365- 368.
10. 刘军, 石文君, 张苏宁. 肺组织瓣包埋金属支架重建气管、食管的动物实验研究. 中华医学杂志, 2011, 91(1): 65-68.
11. 赵俊刚, 张苏宁, 石文君, 等. 自体肺组织瓣内衬记忆合金支架替代长节段气管缺损: 动物实验及临床观察. 中国组织工程研究与临床康复, 2008, 12(22): 4209-4212.
12. 纪子钊, 陈刚, 张苏宁, 等. 记忆合金材料弹力金属支架在犬肺组织瓣重建气管缺损中的应用. 中国组织工程研究与临床康复, 2011, 15(51): 9549-9552.
13. 曹子昂, 顾旭东, 林海平, 等. 自体心包包裹人工气管修复气管缺损的组织相容性评估. 中国组织工程研究与临床康复, 2008, 12(14): 2645-2647.
14. 张银合, 赵凤瑞, 刘德若, 等. 记忆合金网二期成形人工气管实验研究. 中华胸心血管外科杂志, 2004, 20(2): 67-69.
15. Jorge RG, Armengod AC, Caravajal JM. As originally published in 1990: Experimental study of a new porous tracheal prosthesis. Updated in 1998. Ann Thorac Surg, 1998, 65(6): 1830-1831.
16. Schultz P, Vautier D, Charpiot A, et al. Development of tracheal prostheses made of porous titanium: a study on sheep. Eur Arch Otorhinolaryngol, 2007, 264(4): 433-438.
17. Dupret-Bories A, Schultz P, Vrana NE, et al. Development of surgical protocol for implantation of tracheal prostheses in sheep. J Rehabil Res Dev, 2011, 48(7): 851-864.
18. Tan A, Cheng S, Cui P, et al. Experimental study on an airway prosthesis made of a new metastable β-type titanium alloy. J Thorac Cardiovasc Surg, 2011, 141(4): 888-894.
19. Park CH. Histological study of expanded polytetrafluoroethylene (Gore-Tex) implanted in the human nose. Rhinology, 2008, 46(4): 317-323.
20. 李东, 陈东明, 李生, 等. 国产膨体聚四氟乙烯植入大鼠皮下后的相关组织学变化. 中华医学美学美容杂志, 2005, 11(6): 351-354．.
21. Conrad K, Torgerson CS, Gillman GS. Applications of Gore-Tex implants in rhinoplasty reexamined after 17 years. Arch Facial Plast Surg, 2008, 10(4): 224-231.
22. 李文芳, 章杰. 生物材料与鼻整形修复: 作用与地位的可靠性. 中国组织工程研究与临床康复, 2009, 13(34): 6761-6764.
23. Delaere PR. Tracheal transplantation. Curr Opin Pulm Med, 2012, 18(4): 313-320.

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TRACHEA REPAIR AND RECONSTRUCTION WITH NEW COMPOSITE ARTIFICIAL TRACHEA TRANSPLANTATION

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