Tracheal Reconstruction with Porous High-Density Polyethylene Tracheal Prosthesis

Abstract

The variety of methods used for the treatment of severe tracheal stenosis and the occasional failure to obtain lasting and consistent relief are measures of the difficulty of the problem. Presently, several surgical approaches are used for reconstructing large defects of the cervical trachea, reminding us that no single technique has gained wide clinical acceptance. We resected a U-shaped cartilage from 6 to 8 rings of the trachea of 10 New Zealand rabbits. We used a porous high-density polyethylene (PHDP) prosthesis to reconstruct the cervical trachea, and did not perform a tracheotomy during this operation. We followed up the rabbits for 4 to 10 months. One of the rabbits died in the second month because of respiratory distress; another was lost in the fourth month of the study while delivering young. The others continued to thrive; in fact, one of them gave birth 3 times after our study and was well able to take care of her young. At the end of the study, the rabbits were painlessly sacrificed in order to remove the larynx and trachea and examine them histopathologically. In the histopathologic examinations, the prostheses were incorporated into the native trachea and adhered to the surrounding organs, especially to the esophagus. No mucosal irregularities were seen on the surface of the prosthesis, and all the surfaces appeared to be covered with ciliated pseudostratified epithelium. This tracheal prosthesis provides good results in rabbit tracheal reconstruction, and appears very promising for the clinical repair of tracheal defects.

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.…”

“…In this group, anterior cricoid split as a sole treatment modality may be the most suitable expansion procedure, and because of this, the rabbit model may not reflect an appropriate clinical model for simulating grafting techniques . Furthermore, although the laryngotracheal anatomy is largely similar in the rabbit, the thin cricoid cartilage, the long cricothyroid distance, and the dissimilarity of cartilage graft material makes graft insertion difficult during LTR . Due to these factors, rabbit models may be less suited to anterior and posterior grafting techniques, and larger animals with more similar anatomy would be preferred to simulate these procedural steps.…”

“…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.…”

The Reconstruction of Nasal Septal Perforation with High Density Porous Polyethylene Covered with Fascia Lata: An Experimental Study on Rabbit Model

“…To our knowledge, this is the first reported experimental study of HDPP implants used to close septal perforations. We previously demonstrated the successful use of HDPP in tracheal reconstruction in New Zealand rabbits (12), and for this study, we chose the same material and animal model.…”

Current requirements for polymeric biomaterials in otolaryngology

“…Numerous in vitro investigations with respiratory epithelial cells were focused on questions concerning the function of differentiated and undifferentiated cells and to cultivate respiratory epithelial cells on various artificial matrices [70], [71], [72]. In animal experimental models the implantation of membranes or moulds made of various polymers such as polyethylene [73], polypropylene [74], polyetherurethanes [75], polytetrafluorethylene [76], collagen [77] and polypropylene/collagen [78] has been reported. These investigations were aimed to clarify whether the provided structures were repopulated and whether they would differentiate into tissue like structures.…”