Use of a revascularized, tubed costal myoperiosteal graft for repair of circumferential, segmental tracheal defects

Reconstruction of extensive laryngotracheal stenosis continues to pose a si gnificant surgical challenge. Previous work in our laboratory has demonstra ted the utility of vascularized perichondrium for reconstruction of cervica l tracheal defects in a rabbit model. Because most potential vascularized d onor sites in human beings are periosteal, it was important to demonstrate that vascularized periosteum was also useful for laryngotracheal reconstruc tion in a larger animal model. We therefore performed a 2-stage reconstruct ion of a circumferential, segmental cervical tracheal defect using a revasc ularized, tubed myoperiosteal graft in a canine model (n = 8), A rigid, pat ent tube was produced in 6 animals (75%) after completion of the first stag e (7 to 10 weeks). After transfer of the vascularized free graft to the tra cheal defect, 5 of 6 animals survived from 4 to 18 weeks, Severe stenosis ( >90%) was present in 2 animals, and moderate stenosis (40% to 60%) was pres ent in the remaining 3 animals. One animal was observed for 18 weeks and wa s found to have a 40% circumferential stenosis at autopsy. Light microscopy revealed exuberant bone proliferation in all specimens, Unrestrained osteo genesis may limit the utility of vascularized periosteum in reconstruction of extensive tracheal defects.