STAGED REPLACEMENT OF THE CANINE TRACHEA WITH RINGED POLYETHYLENE TEREPHTHALATE GRAFTS

The reconstruction of extensive defects of the trachea ist best accomp lished by the use of the patient's own tissue. Unfortunately, this is not always feasible and several prosthetic devices for replacement of the tracheal have been described. In an experimental study staged trac heal replacements were performed in five dogs using a ringed polyethyl ene terephthalate (PET) tubular prosthesis previously cultured in the major omentum of the subjects. A set of stainless-steel arches embodie d in silicone compound was designed to prevent collapse of the prosthe sis. One of the subjects died on the 10th post-operative day of an uni dentified cause and the remaining four eventually developed signs of r espiratory distress. The cause of the respiratory insufficiency was an astomotic stenosis in every case. Infection, erosion, collapse or disp lacement were not observed. The rings designed to avoid collapse of th e prosthesis represent a suitable alternative for use as external rein forcement in the tracheal situation. The PET grafts implanted as trach eal prosthesis according to the guidelines of this protocol consistent ly developed anastomotic stenosis and failed to support a functional r espiratory epithelium. A further conclusion is that the use of absorba ble sutures encourages anastomotic dehiscence and thus must be avoided .