Autologous tracheal replacement: From research to clinical practice

Fabre, Dominique; Kolb, F.; Fadel, Élie; Leymarie, Nicolas; Mussot, Sacha; Chevalier, Thierry Le; Dartevelle, Philippe

doi:10.1016/j.lpm.2013.07.003

Cited by 11 publications

(17 citation statements)

References 28 publications

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“…f) Positioning of the tracheal graft on the forearm to promote vascularisation and viability before transplantation in the orthotopic position [28]. g) Free fascio-cutaneous flap from the forearm reinforced by cartilage struts [36]. h) Stem cells seeding in the bioreactor before implantation of the bioengineered trachea [41].…”

Section: Porous Prosthesismentioning

confidence: 99%

“…The largest clinical experience was reported by FABRE et al [36]. Instead of being reinforced with an external prosthesis, a free fascio-cutaneous flap from the forearm was reinforced with cartilage struts (figure 1g) [37].…”

Section: Autologous Tissue Compositementioning

confidence: 99%

“…This technique seems to be inappropriate for patients who lack excellent diaphragmatic and respiratory mechanical function to make them capable of effective coughing [38]. Between August 2004 and April 2015, 16 patients were treated at the Marie Lannelongue University Hospital: 12 for primary tracheal neoplasms (nine adenoid cystic carcinomas and three squamous cell carcinomas), three secondary tracheal neoplasms (one thyroid carcinoma and two tracheal lymphomas) and one post-intubation extended tracheal destruction after a long history of stenting [36]. The 5-year survival rate was 64.8%.…”

Section: Autologous Tissue Compositementioning

confidence: 99%

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Tracheal replacement

et al. 2018

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Tracheal reconstruction is one of the greatest challenges in thoracic surgery when direct end-to-end anastomosis is impossible or after this procedure has failed. The main indications for tracheal reconstruction include malignant tumours (squamous cell carcinoma, adenoid cystic carcinoma), tracheoesophageal fistula, trauma, unsuccessful surgical results for benign diseases and congenital stenosis. Tracheal substitutes can be classified into five types: 1) synthetic prosthesis; 2) allografts; 3) tracheal transplantation; 4) tissue engineering; and 5) autologous tissue composite. The ideal tracheal substitute is still unclear, but some techniques have shown promising clinical results. This article reviews the advantages and limitations of each technique used over the past few decades in clinical practice. The main limitation seems to be the capacity for tracheal tissue regeneration. The physiopathology behind this has yet to be fully understood. Research on stem cells sparked much interest and was thought to be a revolutionary technique; however, the poor long-term results of this approach highlight that there is a long way to go in this research field. Currently, an autologous tissue composite, with or without a tracheal allograft, is the only long-term working solution for every aetiology, despite its technical complexity and setbacks.

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Section: Porous Prosthesismentioning

confidence: 99%

Section: Autologous Tissue Compositementioning

confidence: 99%

Section: Autologous Tissue Compositementioning

confidence: 99%

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Tracheal replacement

et al. 2018

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“…The most satisfactory results were achieved with complex flaps composed of an alloplastic material conjugated with host tissues to form a single entity with shared vascular network [ 16 – 19 ]. Also some tissue engineering methods and allotransplantation techniques were tested for their potential application in tracheal reconstruction [ 20 , 21 ]. However, these methods have some drawbacks and limitations as well, such as unavailability of tracheal prostheses in an emergency setting (management of acute posttraumatic defects), need for immunosuppressive therapy, ethical and legal issues, and granulation tissue formation [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Ovine Trachea with a Biomimetic Composite Biomaterial

Ścierski

Lisowska

Namysłowski

et al. 2018

BioMed Research International

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The aim of this study was to evaluate a novel composite material for tracheal reconstruction in an ovine model. A polymer containing various forms of carbon fibers (roving, woven, and nonwoven fabric) impregnated with polysulfone (PSU) was used to create cylindrical tracheal implants, 3 cm in length and 2.5 cm in diameter. Each implant, reinforced with five rings made of PSU-impregnated carbon-fiber roving, had three external layers made of carbon-fiber woven fabric and the inner layer formed of carbon-fiber nonwoven fabric. The inner surface of five implants was additionally coated with polyurethane (PU), to promote migration of respiratory epithelium. The implants were used to repair tracheal defects (involving four tracheal rings) in 10 sheep (9-12 months of age; 40-50 kg body weight). Macroscopic and microscopic characteristics of the implants and tracheal anastomoses were examined 4 and 24 weeks after implantation. At the end of the follow-up period, outer surfaces of the implants were covered with the tissue which to various degree resembled histological structure of normal tracheal wall. In turn, inner surfaces of the prostheses were covered only with vascularized connective tissue. Inner polyurethane coating did not improve the outcomes of tracheal reconstruction and promoted excessive granulation, which contributed to moderate to severe stenosis at the tracheal anastomoses. The hereby presented preliminary findings constitute a valuable source of data for future research on a tracheal implant being optimally adjusted for medical needs.

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“…Most reports suggest 4 to 6cm of trachea or approximately 8 tracheal rings or 50% of the whole tracheal length in adults or 30% in children can be removed, performing pulmonary hilar release, suprahyoid release, and cervical neck flexion to decrease anastomotic tension (2)(3)(4). Longer segments of the trachea cannot be safely removed and since the first reports of tracheal surgery by Hermes Grillo in 1965, it still remains an unsolved problem (5).…”

mentioning

confidence: 99%