Long‐Term Growth of a Vascularized Auricular Perichondrocutaneous Flap in Laryngotracheal Reconstruction

Abstract

This study addresses the potential for ongoing cartilage proliferation after repair of laryngotracheal stenosis with vascularized perichondrium. We randomly assigned 32 New Zealand white rabbits to 1 of 3 groups: group 1 (early cartilage growth, n = 10), group 2 (long-term cartilage growth after pedicle ligation, n = 11), and group 3 (long-term cartilage growth without pedicle ligation, n = 11). Bilateral auricular perichondrocutaneous flaps were elevated and transposed into full-thickness anterior tracheal wall or anterior cricothyroid membrane defects. Six weeks after elevation of the flap, animals were randomly assigned to undergo ligation of either the right or left vascular pedicle (group 2), with the contralateral auricular flap used as a matched control (group 3). Neochondrogenesis was present at 6 weeks in group 1 (0.74 +/- 0.14 mm, n = 12 ears). Cartilage thickness did not differ between groups 2 and 3 one year after ligation of the vascular pedicle: group 2 (0.48 +/- 0.24 mm, n = 18) versus group 3 (0.42 +/- 0.12 mm); P > 0.05. We conclude that in the rabbit model, chondrogenesis did not appear to be ongoing and did not result in late stenosis of the reconstructed airway. Furthermore, delayed ligation of the vascular pedicle neither inhibited nor stimulated cartilage proliferation.

A systematic review of simulated laryngotracheal reconstruction animal models

“…Conversely, several articles highlighted negative aspects of using the rabbit model. The laryngotracheal size was considered only to approximate to very small neonates, and was therefore unsuitable for older infants . Anatomical variances significantly affected the ability to perform LTR.…”

“…The laryngotracheal size was considered only to approximate to very small neonates, and was therefore unsuitable for older infants. 21,39,40 Anatomical variances significantly affected the ability to perform LTR. The laryngotracheal cartilage was considered too thin in comparison to humans, making graft placement difficult.…”

A Tissue-Engineering Technique for Vascularized Laryngotracheal Reconstruction

“…11,12 Other studies used vascularized perichondrium and cartilage for reconstruction of cervical tracheal defects. 13,14 Watson et al 13 designed a free flap of rib and attached pleura, which provided adequate support and a functional conduit in a canine model.…”

Prefabrication of Composite Grafts for Long-Segment Tracheal Reconstruction

“…A variety of prosthetic and tissue grafts (omentum, esophagus, jejunum, perichondrium) have been used, but with only limited success. [17][18][19][20][21] Graft ischemia, immune rejection, anastomotic dehiscence, and stenosis were the major reasons of failure.…”