Laryngotracheal reconstruction in canines - Fixation of autologous costochondral grafts using polylactic cmd polyglycolic acid miniplates

Objective: To examine the feasibility of a new method of laryngotracheal re construction (LTR) that uses a bioabsorbable plating system consisting of p olylactic and polyglycolic acid and provides some advantages over currently used methods. Design and Interventions Anterior subglottic stenosis was created in 10 bea gles that then underwent LTR using an autologous costochondral graft. Exter nal laryngotracheal framework and cartilage grafts were secured using a she et and screws made from a copolymer composed of polylactic and polyglycolic acid. Animals were humanely killed at 40, 60, and 90 days, and specimens w ere submitted for pathological examination. Histologic analysis included ev aluation for inflammatory reaction, polylactic and polyglycolic acid incorp oration into cartilage, cartilage necrosis, cartilage remodeling, and graft epithelialization. Results: All animals underwent LTR after creation of a subglottic stenosis without episodes of airway compromise. After LTR, all airways were returned to prestenosis diameter without significant complication, and all animals were immediately extubated after surgery without difficulty. After the anim als were killed, distraction of the stenotic cricoid area was demonstrated in 100% of the cases. Significant necrosis was noted in 2 of 10 grafts gros sly; however, histologic analysis demonstrated significant areas of viable cartilage, areas of cartilage remodeling, and good epithelialization despit e graft necrosis. Complete epithelialization of grafts was noted in the oth er 8 specimens. Conclusions: Using a canine model, we demonstrated a bioabsorbable plating system that offers an effective method for LTR. This model has the advantag es of providing external support to the operated laryingeal and tracheal fr amework, elimination of the difficulties of suture placement, and potential future failure while offering rigid external fixation of a cartilage graft .