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Zhang Y, Wei S, Li M, Lv G. Revolutionizing tracheal reconstruction: innovations in vascularized composite allograft transplantation. Front Bioeng Biotechnol 2024; 12:1452780. [PMID: 39234265 PMCID: PMC11371696 DOI: 10.3389/fbioe.2024.1452780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024] Open
Abstract
Tracheal defects, particularly those extending over long segments, present substantial challenges in reconstructive surgery due to complications in vascularization and integration with host tissues. Traditional methods, such as extended tracheostomies and alloplastic stents, often result in significant morbidity due to mucus plugging and mechanical erosion. Recent advances in vascularized composite allograft (VCA) transplantation have opened new avenues for effective tracheal reconstruction. This article reviews the evolution of tracheal reconstruction techniques, focusing on the shift from non-vascularized approaches to innovative revascularization methods that enhance graft integration and functionality. Key advancements include indirect revascularization techniques and the integration of regenerative medicine, which have shown promise in overcoming historical barriers to successful tracheal transplantation. Clinical case studies are presented to illustrate the complexities and outcomes of recent tracheal transplantation procedures, highlighting the potential for long-term success through the integration of advanced vascular engineering and immune modulation strategies. Furthermore, the role of chimerism in reducing graft rejection and the implications for future tracheal transplantation and tissue engineering efforts are discussed. This review underscores the transformative potential of VCA in tracheal reconstruction, paving the way for more reliable and effective treatments for extensive tracheal defects.
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Affiliation(s)
- Yiyuan Zhang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Shixiong Wei
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Mingqian Li
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Guoyue Lv
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
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Kapat K, Gondane P, Kumbhakarn S, Takle S, Sable R. Challenges and Opportunities in Developing Tracheal Substitutes for the Recovery of Long-Segment Defects. Macromol Biosci 2024:e2400054. [PMID: 39008817 DOI: 10.1002/mabi.202400054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/21/2024] [Indexed: 07/17/2024]
Abstract
Tracheal resection and reconstruction procedures are necessary when stenosis, tracheomalacia, tumors, vascular lesions, or tracheal injury cause a tracheal blockage. Replacement with a tracheal substitute is often recommended when the trauma exceeds 50% of the total length of the trachea in adults and 30% in children. Recently, tissue engineering and other advanced techniques have shown promise in fabricating biocompatible tracheal substitutes with physical, morphological, biomechanical, and biological characteristics similar to native trachea. Different polymers and biometals are explored. Even with limited success with tissue-engineered grafts in clinical settings, complete healing of tracheal defects remains a substantial challenge due to low mechanical strength and durability of the graft materials, inadequate re-epithelialization and vascularization, and restenosis. This review has covered a range of reconstructive and regenerative techniques, design criteria, the use of bioprostheses and synthetic grafts for the recovery of tracheal defects, as well as the traditional and cutting-edge methods of their fabrication, surface modification for increased immuno- or biocompatibility, and associated challenges.
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Affiliation(s)
- Kausik Kapat
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research Kolkata, 168, Maniktala Main Road, Kankurgachi, Kolkata, West Bengal, 700054, India
| | - Prashil Gondane
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research Kolkata, 168, Maniktala Main Road, Kankurgachi, Kolkata, West Bengal, 700054, India
| | - Sakshi Kumbhakarn
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research Kolkata, 168, Maniktala Main Road, Kankurgachi, Kolkata, West Bengal, 700054, India
| | - Shruti Takle
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research Kolkata, 168, Maniktala Main Road, Kankurgachi, Kolkata, West Bengal, 700054, India
| | - Rahul Sable
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research Kolkata, 168, Maniktala Main Road, Kankurgachi, Kolkata, West Bengal, 700054, India
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