Successful tracheocarinal transplantation

Background When extensive portions of the trachea and carina are resected, grafting is required. Methods. Two experiments were performed in dogs to assess the feasibility o f extensive tracheocarinal replacement using short-segment tracheocarinal a utografts, only to avoid the immunologic complexity of allografts. To deter mine the effect of tension on graft survival, extensive tracheal defects (1 2 to 18 rings) were created in four animals. These were subsequently recons tructed using 6-ring autografts. In the second experiment, three animals un derwent excision of a maximal length of trachea determined in experiment 1 including the carina. Long-term viability of each graft was assessed using bronchoscopy and histologic examination. Results. The limit of tracheal resection successfully reconstructed using a 6-ring autograft was 14 rings (experiment 1). The tracheal grafts in which the tension was greater than 1.2 kg did not maintain their structural inte grity. All of the autografts in experiment 2 were subjected to a tension of less than 1.0 kg at the anastomoses, and showed long-term viability. Conclusions. We conclude that extensive tracheal and carinal defects may be successfully reconstructed using short-segment tracheocarinal grafts if th e anastomoses are subjected to less than 1.0 kg of tension.