Experiences with prosthetic reconstruction of the trachea and bifurcation.

Toomes, H.; Mickisch, GH; Vogt-Moykopf, I.

doi:10.1136/thx.40.1.32

Cited by 64 publications

(38 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Original magnifi cations ! 80. even erosion of the brachiocephalic artery, not infrequently with a fatal result [12,13] . Porous prostheses revealed epithelization to some degree but were also hampered by recurrent infections and the development of stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Tracheal replacement using prostheses was also investigated under clinical conditions using stainless steel [10] , steel coil [11] , silicone [12,13] , polyethylene [14,15] , and Tefl on [16] . Neville silicone prostheses have probably been the most accepted tracheal substitute but are hampered by the lack of epithelization with recurrent suture line granulomas and subsequent stenosis, the tendency to dislodgement and 5.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Repair of Non-Circumferential Cervical Trachea Defects by Three Different Latissimus Dorsi Flaps

Christoforidis

Pezzetta²,

Simon-Valla³

et al. 2005

Eur Surg Res

View full text Add to dashboard Cite

Background: Large intrathoracic airway defects may be closed using a pedicled latissimus dorsi (LD) flap, with rewarding results. This study addresses the question of whether this holds true for extrathoracic non-circumferential tracheal defects. Methods: A cervical segment of the trachea of 4 × 1 cm was resected in 9 white male pigs. The defect was stented with a silicone stent for 3 months and closed either by an LD flap alone (group a, n = 3), an LD flap with an attached rib segment covered by pleura (group b, n = 3), or an LD flap reinforced by a perforated polylactide (MacroPore^®) plate (group c, n = 3). The trachea was assessed by rigid endoscopy at 3 and 4 months and histologically at 4 months postoperatively. Results: The degree of stenosis at the level of the reconstruction at 4 months was 25, 50 and 75% in group a, 15, 50 and 60% in group b, and 20, 95 and 95% in group c, respectively. The percentage of the defect covered by columnar epithelium was 100% in all animals of group a, 60, 100 and 100% in group b, and 10, 0 and 0% in group c. Resorption of the rib was seen in all animals of group b and obstructive inflammatory polyps were found in 2 animals of group c. Conclusion: Pedicled LD flaps provided less satisfactory results for closure of large non-circumferential extrathoracic airway defects than observed after intrathoracic reconstruction. A pedicled rib segment added to the LD flap did not improve the results obtained from LD flap repair alone, and an embedded MacroPore^® prosthesis may result in severe airway stenosis due to plate migration and intense inflammatory reaction protruding into the tracheal lumen.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Repair of Non-Circumferential Cervical Trachea Defects by Three Different Latissimus Dorsi Flaps

Christoforidis

Pezzetta²,

Simon-Valla³

et al. 2005

Eur Surg Res

View full text Add to dashboard Cite

show abstract

“…6,4 cm) k6nnen re--seziert werden, ohne dab nach ausreichender Mobilisation und Anlage einer End-zu-End-Anastomose eine Trachealdehiszenz oder Nahtinsuffizienz zu beffirchten ist [2,19,21,22]. Die Rekonstruktion gr61~erer Trachealdefekte nach Tumorresektion stellt ein bis heute klinisch ungel6stes Problem dar, obgleich zahlreiche experimentelle Einzelstudien durchgeftihrt wurden [1,2,4,15,26,35,36,54,55]. Im Falle prim~ir nicht rekonstruierbarer Trachealdefekte steht der Einsatz alloplastischer und homologer Transplantate zur Diskussion.…”

Section: Diskussionunclassified

Maligne trachealtumoren ? chirurgische Erfahrung bei 6 Patienten mit prim�ren Malignomen der Trachea

Teschner

1996

Langenbecks Arch Chir

View full text Add to dashboard Cite

In a retrospective study six patients with malignant tumours of the trachea located distal to the cricoid and proximal to the carina tracheae were operated on during the period of December 1983 to July 1995 in the Department of Thoracic Surgery in Hannover (Heidehaus). Histopathological examination revealed two adenoid cystic carcinomas, two squamous cell carcinomas, one mucoepidermoid carcinoma, and one low-grade sarcoma. Laser bronchoscopic resection was performed in one patient and tracheotomy one other avoid imminent asphyxia. Physical examination mainly showed a range of symptoms such as stridor and dyspnoea; spirography showed increased airway resistance, and X-ray of the trachea was important in the diagnostic process. The tracheal tumours were diagnosed by histopathological examination of excised material obtained by bronchoscopy. Three patients underwent resection and primary reconstruction of the trachea, with a length of resection between 2.0 and 3.5 cm and end-to-end anastomosis. Endotracheal afterloading was necessary in the case of one female patient with tumour infiltration of the proximal end of the upper trachea. Neoadjuvant irradiation was followed by resection of the whole trachea and implantation of a tracheal prosthesis (Neville) in the case of a patient with extensive endo- and extraluminal tumour infiltration. An extensive recurrence led to the death of this patient 5 months after the surgical intervention. Because of the distal location, resection of the tracheal bifurcation was necessary in two patients, in one combined with a pneumonectomy on the right side. Stenosis of the main bronchus and development of granuloma made stent implantation unavoidable. Dislocation of the stents and recurrent pneumonia caused the patients deaths 74 days and 18 months postoperatively. On follow up 17, 93, and 120 months postoperatively none of the other patients had recurrences. Current diagnostic and therapeutic options for malignant tracheal tumours are discussed.

show abstract

“…From the myriad different materials used [35], the silicone rubber prosthesis, described by Neville and Bolanowski [26], with a non-terminal Dacron ring and telescopic sinking of the prosthesis into the tracheal lumen meets the requisites of air-proof sealing, flexibility to avoid erosion of the innominate artery, good tissue tolerance and resistance to crusting and bacterial invasion. It does not allow the possibility of intraluminal epithelial resurfacing.…”

mentioning

confidence: 99%

“…It does not allow the possibility of intraluminal epithelial resurfacing. Clinical experience has been reported [14,26,27,35,37], and although some selected long-term survivors exist, the procedure seems less than optimal for tracheal reconstruction following extensive resection.…”

mentioning

confidence: 99%

Experimental tracheal reconstruction with free prefabricated arterialized venous flap

Cavadas¹,

Baena-Montilla²,

Vera

1994

Eur J Plast Surg

View full text Add to dashboard Cite

A technique of tracheal reconstruction in the rat model has been developed using the microvascular transfer of a prefabricated compound flap. This flap consists of a tubed cartilage graft incorporated within an arterialized venous flap created in the abdominal skin. Twenty-five Wistar male rats were operated on in three stages. First, the subcutaneous venous network was arterialized by doing an arteriovenous anastomosis. Seven days later, a tube of autologous cartilage was made from the xiphoid cartilage. This neotrachea was buried in a subcutaneous pocket within the arterialized abdominal area. Eight weeks later, the free flap containing the neotrachea, a skin island and a vascular pedicle was transferred to the neck, doing the afferent and efferent anastomosis to the carotid artery and the jugular vein. The neotrachea was interposed into a 1 cm tracheal defect. Microangiography and pathological studies were done in all cases. The pathologic study revealed a stable, viable cartilage tube with an internal lining of fibrous periprosthetic capsule. Angiography demonstrated enhanced vascularization in the abdominal flap. Flap viability was 85%. Postoperative survival ranged from 12 h to 5 days. In all cases, the animal died with a patent airway.

show abstract

Experiences with prosthetic reconstruction of the trachea and bifurcation.

Cited by 64 publications

References 36 publications

Repair of Non-Circumferential Cervical Trachea Defects by Three Different Latissimus Dorsi Flaps

Repair of Non-Circumferential Cervical Trachea Defects by Three Different Latissimus Dorsi Flaps

Maligne trachealtumoren ? chirurgische Erfahrung bei 6 Patienten mit prim�ren Malignomen der Trachea

Experimental tracheal reconstruction with free prefabricated arterialized venous flap

Contact Info

Product

Resources

About