Abstract Objective: No vascular pedicle can be obtained reasonably to provide revascularization of a tracheal graft by direct microvascular suture. This study is a morphometric analysis of epithelial regeneration, submucosal revascularization, and mucosal thickness of isolated, tracheal segments revascularized by a lateral thoracic fascial flap. The purpose of the first part of the study is to determine the optimal period of tracheal viability after isolation and revascularization. The second part consisted of a reimplantation of the revascularized autograft into its original tracheal location. Design: A tracheal segment was excised in 30 animals, and the segment was wrapped in the lateral thoracic fascia. The segments were reviewed histologically and morphometrically 2 to 28 days after graft isolation and after injection of the lateral thoracic artery with a blue silicone dye. Twelve grafts were reimplanted. Six segments were reinserted in the original direction and six segments were reinserted in the opposite direction. Tracheal airway clearance was studied by observation of the movement of carbon particles placed at different locations on the native and transplanted tracheal mucosa. Mean Outcome Measures: Tracheal autograft revascularization and reepithelialization. Results: Histologic evaluation of the revascularized grafts revealed an optimal viability of the autograft 16 to 20 days after isolation. The autografts could be reimplanted successfully after this period. This demonstrated the viability of the isolated grafts after a revascularization period of 16 days. The original direction of the mucosal clearance was preserved after reimplantation. The clearance in the opposite direction, with the 180° rotated segments, however, had no influence on survival.(Arch Otolaryngol Head Neck Surg. 1994;120:1130-1136) References 1. Grillo HC, Dignan EF, Miura T. Extensive resection and reconstruction of mediastinal trachea without prosthesis or graft: an anatomical study in man . J Thorac Cardiovasc Surg . 1964:48:741-749. 2. Grillo HC. Tracheal replacement . Ann Thorac Surg . 1990;49:864-865.Crossref 3. Davies OG, Edmiston JM, McCorkle HC. The repair of experimental tracheal defects with fresh and preserved homologous tracheal grafts . J Thorac Surg . 1952;23:367-376. 4. Rose KG, Sesterhenn K, Wustrow F. Tracheal allotransplantation in man . Lancet . 1979;1:433-436.Crossref 5. Spinazzola AJ, Graziano JL, Neville WE. Experimental reconstruction of the tracheal carina . J Thorac Cardiovasc Surg . 1969;58:1-13. 6. Brent B, Upton J, Acland RD, Shaw WW, Finseth FJ. Experience with the temporoparietal fascial free flap . Plast Reconstr Surg . 1985;76:177-188.Crossref 7. Delaere PR, Mebis J, Ostyn F, Boeckx W, Feenstra L. Experimental transferable vascular bed for laryngotracheal reconstruction—further observations . Ann Otol Rhinol Laryngol . 1993;102:144-151. 8. Delaere PR, Ziying L, Pauwels P, Feenstra L. Experimental revascularization of the airway wall. Laryngoscope. In press. 9. Morgan E, Lima O, Goldberg M, Ferdman A, Luk SK, Cooper JD. Successful revascularization of totally ischemic bronchial autografts with omental pedicle flaps in dogs . J Thorac Cardiovasc Surg . 1982;84:204-210. 10. Balderman SC, Weinblatt G. Tracheal autograft revascularization . J Thorac Cardiovasc Surg . 1987;94:434-441. 11. Keenan KP, Wilson TS, McDowell EM. Regeneration of hamster epithelium after mechanical injury . Virchows Arch B Cell Pathol . 1983;43:213-240.Crossref 12. Gordon AE, Lane BP. Ciliated cell differentiation in regenerating rat tracheal epithelium . Lung . 1984;162:233-243.Crossref 13. Mayer E, Cardoso PFG, Puskas JD, et al. The effect of basic fibroblast growth factor and omentopexy on revascularization and epithelial regeneration of heterotopic rat tracheal isografts . J Thorac Cardiovasc Surg . 1992;104:180-188.
Archives of Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Oct 1, 1994