PREFABRICATED JEJUNAL FREE-TISSUE TRANSFER FOR TRACHEAL RECONSTRUCTION - AN EXPERIMENTAL-STUDY

Reconstruction of long-segment tracheal defects is a problem for the r econstructive surgeon. Difficulties arise with the use of prosthetic m aterials because of their propensity for infection and extrusion. Auto logous tissue is limited by poor structural characteristics and techni cal complexity. We propose a simple composite bioprosthesis that, thro ugh a process of prefabrication and subsequent neovascularization, may provide a functional tracheal analogue superior to existing forms of reconstruction. Ten rats had composite flaps constructed by combining an isolated, perfused, mucosectomized segment with an outer covering o f a ring-reinforced woven Dacron vascular graft. This unit remained in die intraabdominal milieu for 20 days and was then inspected for viab ility, incorporation of jejunum and graft, flexibility, and tolerance to negative pressure. Seven experimental animals survived the initial phase. The jejunal bioprostheses in all cases tolerated negative press ures to -200 mmHg, rotation of 180 degrees, and flexion to 90 degrees without collapse of the graft segments. Vascular casts and standard hi stologic examination showed neovascularization of the Dacron graft and dense fibrovascular ingrowth into the interstices of the graft. We co nclude that prefabrication utilizing autologous and prosthetic compone nts to create a single axial flap for transfer is a feasible solution to long-segment tracheal reconstruction. Neovascularization permeates the full thickness of the prosthetic component and is accompanied by d ense fibrous ingrowth during the delay period. This neotracheal analog ue also possesses structural characteristics similar to those of the n ative trachea and a durable submucosal layer that can support ingrowth of epithelium.