Tracheal reconstruction with a free vascularized myofascial flap: preclinical investigation in a porcine model to human clinical application

Abstract

Although there are various methods for tracheal reconstruction, such as a simple approximation with suturing and coverage with adjacent soft tissue or muscle, large defects >50% of the tracheal length still present a clinical challenge. Tissue engineering, a recent promising way to possibly resolve this problem, requires a long preparatory period for stem cell seeding on a scaffold and relatively invasive procedures for stem cell harvesting. As an alternative, we used a vascularized myofascial flap for tracheal reconstruction. In four porcine models, the deep inferior epigastric perforator (DIEP) was used in two and the superior epigastric artery perforator (SEAP) in two. Transformation of the surface of the transplanted myofascial flap was analyzed in the airway environment. The flaps failed in the DIEP group due to venous congestion. At 12 weeks postoperatively, none of SEAP group showed any signs of respiratory distress; the inner surface of the implant exhibited stratified squamous epithelium with sparse cilia. In the clinical setting, a patient who underwent a tracheal reconstruction with a vascularized myofascial flap and 2-year follow-up was in good health with no respiratory distress symptoms.

The free neurovascular transverse wrist crease flap for repairing soft tissue defects of the fingers: clinical outcomes of multiple centers

“…Soft tissue defects of the fingers with bone, tendon, or joint exposure are common injuries in hand traumas [1, 2]. To preserve finger length and function, flap transplantation rather than skin graft is usually performed to reconstruct the defective soft tissue.…”

Biomimetic materials to replace tubular tissues

“…Similarities in the structural and compositional features across different tubular tissues.Center, schematic histological transversal cross-sections, associated with scanning electron microscopy (SEM) and transmission electron microscopy (TEM) images of epithelia for each tissue. Trachea, chicken (For tracheal epithelium electron microscopy observations, biopsies sourced from camel296 , rats297 , dogs298 and porcine299 were found, but not from humans. ): (SEM) group of mature goblet cells on the luminal surface, exhibiting sparse microvilli on the peripheral surface16 .…”