Skip to main content
Log in

Experimental bioprosthetic reconstruction of the trachea

  • Published:
Archives of oto-rhino-laryngology Aims and scope Submit manuscript

Summary

We removed the tracheas from sacrificed laboratory animals and subjected this tissue to multistep chemical processing. This method allowed us to preserve the cartilage and reduce its antigenicity, thus creating a bioprosthesis very similar to the host tissue. By using allogeneic and xenogeneic prostheses so prepared, no signs of immune rejections were seen following heterotopic or orthotopic implantations. The transplanted cartilage remained stable for periods ranging up to 21 weeks in recipient rats, while partial morphologic integrity of the cartilage was seen up to 1 year in pigs. Reepithelialization of the transplant with ciliated epithelium was completed in all specimens 12–24 weeks following surgery. Segmental replacement of up to one third of the whole trachea was possible in rats, whereas similar segmental replacements failed in pigs. We also found that successful reconstruction of window-shaped defects was possible. We consider our tracheal bioprosthesis to be superior to cialit-preserved grafts and also to most other biological reconstruction procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Aletras H, Katsohis C, Anguridakis C (1982) A new method of repairing extensive tubular tracheal defects. Scand J thorac Cardiovasc Surg 16:191–195

    Google Scholar 

  2. Alonso WA, Bridger GP, Bordley JE (1972) Tracheal transplantation in dogs. Laryngoscope 82:204–209

    Google Scholar 

  3. Bailey BJ, Kosoy J (1970) Observations in the development of tracheal prostheses and tracheal transplantation. Laryngoscope 80:1553–1565

    Google Scholar 

  4. Beall AC, Harrington OB, Greenberg SD, Morris CG, Usher FC (1963) Tracheal reconstruction with heavy marlex mesh. Arch Surg 86:970–978

    Google Scholar 

  5. Beck Ch (1968) Kritische Betrachtungen zur Trachealplastik mit Kunststoffspangen. Arch Oto-Rhino-Laryngol 1971:727–732

    Google Scholar 

  6. Beigel A, Müller-Buchholtz W (1984) Tracheal transplantation. I. The immunogenic effect of rat tracheal transplants. Arch Otorhinolaryngol 240:185–192

    Google Scholar 

  7. Beigel A, Müller-Buchholtz W (1984) Tracheal implantation. II. Influence of genetic difference and degree of resuscitation on reactions to tracheal transplant. Arch Otorhinolaryngol 240:217–225

    Google Scholar 

  8. Beigel A, Steffens-Knutzen R, Müller B, Gehnmacher U, Stein (1984) Tracheal transplantation. III. Demonstration of transplantation antigens on the tracheal mucose of inbred rat strains. Arch Otorhinolaryngol 241:1–8

    Google Scholar 

  9. Berghaus A (1984) Auto-alloplastic tracheal replacement prosthesis. Basic and experimental investigations. In: Anderson JM (ed) Biomaterials 1984, vol VII 299

  10. Bottema JR, Feijen F, ten Hoopen HWM, Molenaar J, Wildevuur CRH (1980) Microporous tracheal prosthesis: incorporation and prevention of infection. Trans Am Soc Artif Intern Organs 26:412–417

    Google Scholar 

  11. Bottema JR, Heilkamp A, ten Hoopen HWM, Feigen J, Wildevuur CRH (1982) Comparison of Teflon with microporous polysulphene and biological materials. In: Bottema JR (ed) The microporous tracheal prosthesis. Dissertation, Rijksuniversitaet Groningen, pp 103–118

  12. Bryant LR (1964) Replacement of tracheobronchial defects with autogenous pericardium. J Thorac Cardiovasc Surg 48:733–740

    Google Scholar 

  13. Bucher RM, Burnett WE, Rosemond GF (1951) Experimental reconstruction of tracheal and bronchial defects with stainless steel wire mesh. J Thorac Cardiovasc Surg 21:572–583

    Google Scholar 

  14. Burnett WE (1950) Dermal grafts for tracheobronchial reconstruction. J Thorac Cardiovasc Surg 20:650

    Google Scholar 

  15. Caputo V, Consiglio V (1961) The use of patients own auricular cartilage to repair deficiency of the tracheal wall. J Thorac Cardiovasc Surg 41:594–596

    Google Scholar 

  16. Correl NO (1956) The characteristics of regeneration of respiratory epithelium. Surg Gynecol Obstet 103:209–211

    Google Scholar 

  17. Craig RL, Holmes GW, Shabaret EJ (1953) Tracheal resection and replacement with a prosthesis. J Thorac Cardiovasc Surg 25:384–396

    Google Scholar 

  18. Dahlke W, Dociu N, Zehm S (1977) Über das intratracheale Verhalten des Haut-Knorpel-Transplantates nach Stenoseoperationen. Arch Otorhinolaryngol 215:597

    Google Scholar 

  19. Eliacher J, Goldsher M, Moscona AR, Hurwitz DJ (1984) Reconstruction of the larynx and cervical trachea with the pectoralis major myocutaneous island flop. Head Neck Surg 6:880–883

    Google Scholar 

  20. Ellis PR, Harrington OB, Beall AC, De Bakey ME (1962) The use of heavy marlex mesh for tracheal reconstruction following resection for malignancy. J Thorac Cardiovasc Surg 44:520–527

    Google Scholar 

  21. Feldman D, Estridge T (1984) Factors affecting soft tissue ingrowth into porous materials. In: Anderson JM (ed) Biomaterial transaction, 2nd World Congress V II:37

  22. Fleming J, Hommerich KW (1968) Homotransplantation der Trachea im Tierexperiment. Arch Otorhinolaryngol 191:724–727

    Google Scholar 

  23. Foet K (1980) Untersuchungen zum Trachealersatz durch homologe Segmentimplantate. In: Cotta H, Martini AK (eds) Implantate and Transplantate in der plastischen und Wiederherstellungschirurgie. Springer, Berlin Heidelberg New York, 310–315

    Google Scholar 

  24. Gabas S (1982) Cited from Mayer R: Reconstructive surgery of the trachea. Thieme, Stuttgart

    Google Scholar 

  25. Gebauer PW (1951) Reconstructive surgery of the trachea and the bronchi. Late results with dermal grafts. J Thorac Cardiovasc Surg 22:568–583

    Google Scholar 

  26. Greenberg SD (1958) Tracheal homografts in dogs. Arch Otorhinolaryngol 67:577–586

    Google Scholar 

  27. Grillo HC (1982) Primary reconstruction of airway resection of subglottic laryngeal and upper tracheal stenosis. Ann Thorac Surg 33:3–18

    Google Scholar 

  28. Grillo HC, Dignan EF, Miura T (1964) Extensive resection and reconstruction of mediastinal trachea without prosthesis or graft: an anatomical study on man. J Thorac Cardiovasc Surg 48:741–749

    Google Scholar 

  29. Grosse D (1901) Trachealknorpeldefekt und Silberdrahtnetzdeckung. Zentralbl Chir 28:1110–1111

    Google Scholar 

  30. Gussenbauer C (1874) Über die erste durch Th. Billroth am Menschen durchgeführte Kehlkopfexstirpation und die Anwendung eines künstlichen Kehlkopfes. Langenbeck's Arch Chir 17:341–342

    Google Scholar 

  31. Hanner JM, Cohen SH (1953) Repair by full thickness skin graft of penetrating wounds of intrathoracic trachea. J Thorac Cardiovasc Surg 25:380–383

    Google Scholar 

  32. Herberhold C, Franz B, Breipohl W (1980) Chemisch konservierte menschliche Tracheas als Prothesematerial zur Deckung trachealer Defekte. Laryngol Rhinol Otol 59:453–457

    Google Scholar 

  33. Heyner S (1969) The significance of the intracellular matrix in the survival of cartilage allografts. Transplantation V 8:666–677

    Google Scholar 

  34. Hofmann D, Filler D, Fritz DW, Jander R (1980) Alloplastischer Trachealersatz mit Biocarbonen. Langenbecks Arch Chir 350:199–206

    Google Scholar 

  35. Holwick JL, Klein SR, Sproat RW, Miranda RM, Hirose FM, White RA, Nelson RJ (1980/1981) Healing of a new microporous tracheal prosthesis. Surg Forum 31/32: 541–543

    Google Scholar 

  36. Ilberg C v, Kitano S, Schmidt A (1977) Das Cialit-konservierte Trachealtransplantat. Laryngol Rhinol Otol 56:814–823

    Google Scholar 

  37. Jarvis FJ (1950) Dermal grafts for trachealbronchial reconstruction. J Thorac Cardiovasc Surg 20:645–650

    Google Scholar 

  38. Kaiser D (1984) Alloplastischer Tracheateilersatz mit Dacron an der Hundetrachea. J Thorac Cardiovasc Surg [Suppl] 32:31

    Google Scholar 

  39. Kolodziej J, Orlowski TM (1984) Eine experimentelle Studie über die Chirurgie intrathorakaler Trachealstenosen. J Thorac Cardiovasc Surg [Suppl] 32:35

    Google Scholar 

  40. Kornmesser HJ (1970) Tierexperimentelle Untersuchungen mit Replantation kompletter Trachealsegmente. Arch Otorhinolaryngol 196:354–356

    Google Scholar 

  41. Küster E (1886) Über narbige Stenosen der Trachea. Zentralbl Chir 13:759–760

    Google Scholar 

  42. Marrangoni AG (1951) Homotransplantation of tracheal segments preserved by lyophilisation; an experimental study. J Thorac Cardiovasc Surg 21:398–401

    Google Scholar 

  43. McCaughan JS (1968) Tracheal reconstruction with silastic reinforced dacron. Arch Otorhinolaryngol 67:150–151

    Google Scholar 

  44. Mégevand R, Sideris C, Duruz H (1969) Reimplacement de la trachée par greffe allogénique lyophilisée. Helv Chir Acta 63:335–342

    Google Scholar 

  45. Meyer R (1982) Reconstructive surgery of the trachea. Thieme, Stuttgart, pp 8–26

    Google Scholar 

  46. Moritz E (1977) Untersuchungen zum alloplastischen Trachealersatz. Fortschr Med 95:173–176

    Google Scholar 

  47. Mortola JP, Sant'Ambrogio G (1979) Mechanics of the trachea and behaviour of its slowly adapting stretch receptors. J Physiol 286:577–590

    Google Scholar 

  48. Naef AP (1969) Tracheobronchiale Rekonstruktion nach ausgedehnter Trachearesektion. Thoraxchirurgie 17:503–511

    Google Scholar 

  49. Narodick BG, Pemberton AH, Worman LW (1964) Tracheoplasty by means of a periosteal pedicle graft. J Thorac Cardiovasc Surg 47:572–576

    Google Scholar 

  50. Nelson RJ, White RA, Lawrence RS, Walkinshaw MD, Fiaschetti FL, White EW, Hirose FM (1979) Development of a new microporous tracheal prosthesis. Trans Am Soc Artif Intern Organs 25:8–12

    Google Scholar 

  51. Neville WE, Hamouda F, Andersen J, Dwan FM (1974) Replacement of the intrathoracic trachea and both stem bronchi with a molded silastic prosthesis. J Thorac Cardiovasc Surg 63:569–576

    Google Scholar 

  52. Onishi K, Takahama T, Kanai F, Iizukuda I, Hiraishi M, Tanaka Y, Wada T, Asano K, Nakabayashi N, Miyata T, Sonoda T (1984) Application of new apatite ceramics to tracheal prosthesis. Eur Surg Res [Suppl] 16:88

    Google Scholar 

  53. Pearson FG, Henderson RD, Gross AE, Ginsberg RJ, Stone RM (1968) The reconstruction of circumferential tracheal defects with a porous prosthesis. J Thorac Cardiovasc Surg 55:605–616

    Google Scholar 

  54. Pinter H (1983) Segmentaler Trachealersatz mit resorbierbarem Material. Acta Chir Aust 15:77–83

    Google Scholar 

  55. Pressman JJ, Simon MB (1961) Observations upon the experimental repair of the trachea using autogenous aorta and polyethylene tubes. Surg Gynecol Obstet 106:56–62

    Google Scholar 

  56. Rathcke L (1951) Der Verschluß von Defekten in der Trachea mittels reiner Fascientransplantationen im Tierversuch. Langenbecks Arch Chir 270:237–239

    Google Scholar 

  57. Reich L, Schmieg E (1977) Verwendung von Cialit-fixiertem Knorpel bei Trachealplastik, HNO 25:428–429

    Google Scholar 

  58. Römer KH (1961) Dünndarm-serosa-muscularis bezogene V2A-Spiralen als Ersatz für komplette Systeme des Tracheobronchialbaumes im Tierversuch. Langenbecks Arch Chir 298:781–786

    Google Scholar 

  59. Rose KG, Sesterhenn K, Wustrow F (1979) Vorbereitung, Ausführung und erste Erfahrungen mit der allogenen Frischtransplantation der Trachea beim Menschen. Arch Otorhinolaryngol 223:274

    Google Scholar 

  60. Sabas AA, Hez JB, Rojas C, Jones RA, Arangaren JA (1977) Replacement of the trachea with dura mater. J Thorac Cardiovasc Surg 74:761–765

    Google Scholar 

  61. Sato R, Hasegawa I, Nakagawa J (1957) Experimental study of tracheal reconstruction. J Thorac Cardiovasc Surg 34:526–538

    Google Scholar 

  62. Sauer BW, Lade RB (1982) Porous high density polyethylene (PHDPE) autogenous tissue tracheal prosthesis. Trans Am Soc Artif Intern Organs 28:360–373

    Google Scholar 

  63. Schobel H (1959) Die Trachealplastik mittels Kunststoff- und Edelmetallspangen. Arch Otorhinolaryngol 180:496–502

    Google Scholar 

  64. Schölzel E, Petropoulos P, Spyker M, Uhlschmid C (1978) Die Revitalisierung des bovinen Xenograft als Trachea- und Gefäßersatz beim Hund. Langenbecks Arch Chir 347:694–695

    Google Scholar 

  65. Sesterhenn K, Rose KG (1977) Die Trachealtransplantation im Tierexperiment. I. Operationstechnik. Laryngol Rhinol Otol 56:643–649

    Google Scholar 

  66. Sesterhenn K, Rose KG (1979) Die Trachealtransplantation im Tierexperiment. II. Überlebensdauer und makroskopische Befunde nach auto-, iso- und allogenen Trachealtransplantationen. Laryngol Rhinol Otol 58:224–232

    Google Scholar 

  67. Sesterhenn K, Rose KG (1979) Die Trachealtransplantation im Tierexperiment. III. Das histologische Substrat der Host-versus-Graft (HvG) Reaktion. Laryngol Rhinol Otol 58:502–508

    Google Scholar 

  68. Sesterhenn K, Rose KG (1979) Die Trachealtransplantation im Tierexperiment. IV. Histologische und histoautoradiographische Befunde am Epithel. Laryngol Rhinol Otol 58:502–508

    Google Scholar 

  69. Shimizu Y, Miyamoto Y, Teramatsu T, Hino T, Shibata U, Okamura S (1980) Collagen-coated polypropylene nushes for reconstructive surgery of the trachea. Biomaterials. Wiley, pp 745–749

    Google Scholar 

  70. Staindl O, Lametschwandtner A, Zimmermann G, Adam H (1979) Ergebnisse heterologer Trachealtransplantate im Tierexperiment. I. HNO 27:7–13

    Google Scholar 

  71. Staindl O, Lametschwandtner A, Albrecht U (1981) Experimental study of human heterografts in pigs. Chir Plast 6:69–73

    Google Scholar 

  72. Strauss P, Gorris A, Lanz W (1980) Versuche zum autoplastischen Trachealersatz beim Kaninchen. Laryngol Rhinol Otol 59:458–466

    Google Scholar 

  73. Swift EA, Grindley JH, Clagett OT (1952) The repair of tracheal defects with fascia and tantalum mesh: an experimental study. J Thorac Cardiovasc Surg 24:482–492

    Google Scholar 

  74. Ta Mei W, Pen-nien Y, Chen-chiang W, Wen-hui W (1982) Surgical management of laryngo-tracheal stenosis resulting from posttraumatic scarring. Chir Plast 7:35–42

    Google Scholar 

  75. Tauro JC, Parsons JR, Ricci JC, Alexander H, Weiss AB (1984) Comparison of antigen extracted, lyophilized and glutaraldehyde-fixed bovine xenograft: a preliminary study. In: Anderson J (ed) Trans Second World Congr on Biomaterials, vol III, p 257

  76. Toomes H, Lülig H, Vogt-Moykopf I, Weidauer H (1984) Der prothetische Trachealersatz. J Thorac Cardiovasc Surg [Suppl] 32:31–32

    Google Scholar 

  77. Weerda H, Schuhmann K (1980) Unsere Erfahrungen mit der Trachealchirurgie. HNO 28:291–300

    Google Scholar 

  78. Weidauer H (1980) Das Cialit-konservierte Trachealtransplantat im Tierversuch. In: Cotta H, Martini AK (eds) Implantate and Transplantate in der plastischen und Wiederherstellungschirurgie. Springer, Berlin Heidelberg New York, pp 316–317

    Google Scholar 

  79. Weidenbecher M, Gentsch H (1980) Segmentresektion zur Behandlung der cervikalen Trachealstenosen. HNO 28:336–342

    Google Scholar 

  80. Westaby S, Jackson JW, Pearson FG (1982) A bifurcated silicone rubber stent for relief of trachealbronchial obstruction. J Thorac Cardiovasc Surg 83:414–417

    Google Scholar 

  81. Wilfingseder P (1972) Rekonstruktion der Trachea durch ein Segmenttransplantat vom Nasenseptum. Wien Klin Wochenschr 84:226–229

    Google Scholar 

  82. Woodruff MFA (1960) The transplantation of organs and tissues. Charles C. Thomas, Springfield, Illinois

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scherer, M.A., Ascherl, R., Geißdörfer, K. et al. Experimental bioprosthetic reconstruction of the trachea. Arch Otorhinolaryngol 243, 215–223 (1986). https://doi.org/10.1007/BF00464433

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00464433

Key words

Navigation