Jc. Banis et al., PREFABRICATED JEJUNAL FREE-TISSUE TRANSFER FOR TRACHEAL RECONSTRUCTION - AN EXPERIMENTAL-STUDY, Plastic and reconstructive surgery, 98(6), 1996, pp. 1046-1051
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.