TRACHEAL AUTOGRAFT REVASCULARIZATION AND TRANSPLANTATION

Objective: No vascular pedicle can be obtained reasonably to provide r evascularization of a tracheal graft by direct microvascular suture. T his study is a morphometric analysis of epithelial regeneration, submu cosal revascularization, and mucosal thickness of isolated, tracheal s egments revascularized by a lateral thoracic fascial flap. The purpose of the first part of the study is to determine the optimal period of tracheal viability after isolation and revascularization. The second p art consisted of a reimplantation of the revascularized autograft into its original tracheal location. Design: A tracheal segment was excise d in 30 animals, and the segment was wrapped in the lateral thoracic f ascia. The segments were reviewed histologically and morphometrically 2 to 28 days after graft isolation and after injection of the lateral thoracic artery with a blue silicone dye. Twelve grafts were reimplant ed. Six segments were reinserted in the original direction and six seg ments were reinserted in the opposite direction. Tracheal airway clear ance was studied by observation of the movement of carbon particles pl aced at different locations on the native and transplanted tracheal mu cosa. Mean Outcome Measures: Tracheal autograft revascularization and reepithelialization. Results: Histologic evaluation of the revasculari zed grafts revealed an optimal viability of the autograft 16 to 20 day s after isolation. The autografts could be reimplanted successfully af ter this period. This demonstrated the viability of the isolated graft s after a revascularization period of 16 days. The original direction of the mucosal clearance was preserved after reimplantation. The clear ance in the opposite direction, with the 180 degrees rotated segments, however, had no influence on survival.