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Tseng WH, Liu EW, Cheng KY, Wee SJ, Lee JJ, Chen HC. Tracheal Replacement Techniques and Associated Mortality: A Systematic Review. Laryngoscope 2024; 134:1517-1522. [PMID: 37916766 DOI: 10.1002/lary.31100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Tracheal replacement is a crucial operation to enhance the quality of life for patients with extensive tracheal lesions. The most suitable surgical techniques for different clinical conditions remain a topic of debate. Through a reviewing of the relevant literature, this study investigated the association between surgical techniques and mortality rate. DATA SOURCES Studies were collected from PubMed, Embase, the Web of Science, the Cochrane Center Register of Controlled Trials, and ClinicalTrials.gov. METHODS This systematic review encompassed literature from the inception of each database to May 10, 2023, focusing on tracheal replacement for patients who underwent circumferential resection of the trachea or partial resection with preservation of the posterior membranous wall. Non-human and non-clinical studies were excluded. RESULTS About 31 studies were included in the assessment comprising a combination of case reports and case series, and 118 patients underwent tracheal replacement through four underlying methodologies, including tracheal allotransplantation, autologous tissue reconstruction, bioprosthetic reconstruction, or tissue engineering surgery. Each modality exhibits unique advantages and disadvantages, leading to variable outcomes in clinical application. CONCLUSION Tracheal replacement is challenging due to the absence of an ideal substitution or graft material. Despite limited clinical successes observed across various modalities, we believe autologous tissue reconstruction for tracheal replacement has the advantage of broadest indications, low rejection rate, and avoidance of immunosuppressive agents. Future research should focus on achieving tracheal replacement that preserves mucociliary clearance, lateral rigidity, and longitudinal flexibility. LEVEL OF EVIDENCE NA Laryngoscope, 134:1517-1522, 2024.
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Affiliation(s)
- Wen-Hui Tseng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - En-Wei Liu
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Kai-Yuan Cheng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Shyun-Jing Wee
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Jian-Jr Lee
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
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2
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de Frémicourt K, Wurtz A, Georgescu D, Sarsam M. Extended autologous tracheal replacement by a novel pedicled thoraco-chondro-costal flap: a cadaveric proof of concept. Eur J Cardiothorac Surg 2024; 65:ezae063. [PMID: 38400739 DOI: 10.1093/ejcts/ezae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/21/2023] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES Our aim was to report an anatomic model of an autologous flap based on the internal thoracic blood supply: the pedicled thoraco-chondro-costal flap; and establish the feasibility of various types of extended tracheal replacement with this novel flap, according to a newly proposed topographic classification. METHODS In a cadaveric model, a cervicotomy combined with median sternotomy was performed. The incision was extended laterally to expose the chest wall. The internal thoracic pedicle was freed from its origin down to the upper limit of the delineated flap to be elevated. The perichondria and adjacent periostea were incised longitudinally to remove cartilages and adjacent rib segments, preserving perichondria and periostea. A full-thickness quadrangular chest wall flap pedicled on internal thoracic vessels was then elevated and shaped into a neo conduit to replace the trachea with the pleura as an inner lining. RESULTS Various types of extended non-circumferential and full-circumferential tracheal replacements were achieved with this composite flap. No anastomosis tension was noticed despite the absence of release manoeuvres. CONCLUSIONS This model could represent a suitable autologous tracheal substitute, which is long, longitudinally flexible and eventually transversely rigid. No microsurgical vascular anastomoses are required. The technique is reproducible. The perichondria and periostea would regenerate vascularized neo-cartilaginous rings, potentially decreasing the need for long-term stenting. The inner pleural lining could potentially transform into ciliated epithelium as shown in previous preclinical studies.
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Affiliation(s)
- Kim de Frémicourt
- Department of ENT and Oncological Surgery, Henri Becquerel Anticancer Center, Rouen, 1 Rue d'Amiens, 76038, Rouen, France
| | - Alain Wurtz
- Lille University, 1 Pl. de Verdun, Lille, 59000, France
| | - Dragos Georgescu
- Department of ENT and Oncological Surgery, Henri Becquerel Anticancer Center, Rouen, 1 Rue d'Amiens, 76038, Rouen, France
| | - Matthieu Sarsam
- Department of Thoracic and Cardiac Surgery, Rouen University Hospital, 37 Bd Gambetta, 76000, Rouen, France
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3
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Sun F, Shen Z, Zhang B, Lu Y, Shan Y, Wu Q, Yuan L, Zhu J, Pan S, Wang Z, Wu C, Zhang G, Yang W, Xu X, Shi H. Biomimetic in situ tracheal microvascularization for segmental tracheal reconstruction in one-step. Bioeng Transl Med 2023; 8:e10534. [PMID: 37476057 PMCID: PMC10354772 DOI: 10.1002/btm2.10534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 07/22/2023] Open
Abstract
Formation of functional and perfusable vascular network is critical to ensure the long-term survival and functionality of the engineered tissue tracheae after transplantation. However, the greatest challenge in tracheal-replacement therapy is the promotion of tissue regeneration by rapid graft vascularization. Traditional prevascularization methods for tracheal grafts typically utilize omentum or muscle flap wrapping, which requires a second operation; vascularized segment tracheal orthotopic transplantation in one step remains difficult. This study proposes a method to construct a tissue-engineered tracheal graft, which directly forms the microvascular network after orthotopic transplantation in vivo. The focus of this study was the preparation of a hybrid tracheal graft that is non-immunogenic, has good biomechanical properties, supports cell proliferation, and quickly vascularizes. The results showed that vacuum-assisted decellularized trachea-polycaprolactone hybrid scaffold could match most of the above requirements as closely as possible. Furthermore, endothelial progenitor cells (EPCs) were extracted and used as vascularized seed cells and seeded on the surfaces of hybrid grafts before and during the tracheal orthotopic transplantation. The results showed that the microvascularized tracheal grafts formed maintained the survival of the recipient, showing a satisfactory therapeutic outcome. This is the first study to utilize EPCs for microvascular construction of long-segment trachea in one-step; the approach represents a promising method for microvascular tracheal reconstruction.
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Affiliation(s)
- Fei Sun
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Zhiming Shen
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Boyou Zhang
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Yi Lu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Yibo Shan
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Qiang Wu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Lei Yuan
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Jianwei Zhu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Shu Pan
- Department of Thoracic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zhihao Wang
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Cong Wu
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Guozhong Zhang
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
| | - Wenlong Yang
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
| | - Xiangyu Xu
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Hongcan Shi
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
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Xu C, Ma Y, Huang H, Ruan Z, Li Y. A Review of Woven Tracheal Stents: Materials, Structures, and Application. J Funct Biomater 2022; 13:jfb13030096. [PMID: 35893464 PMCID: PMC9326637 DOI: 10.3390/jfb13030096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
The repair and reconstruction of tracheal defects is a challenging clinical problem. Due to the wide choice of materials and structures, weaving technology has shown unique advantages in simulating the multilayer structure of the trachea and providing reliable performance. Currently, most woven stent-based stents focus only on the effect of materials on stent performance while ignoring the direct effect of woven process parameters on stent performance, and the advantages of weaving technology in tissue regeneration have not been fully exploited. Therefore, this review will introduce the effects of stent materials and fabric construction on the performance of tracheal stents, focusing on the effects of weaving process parameters on stent performance. We will summarize the problems faced by woven stents and possible directions of development in the hope of broadening the technical field of artificial trachea preparation.
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Affiliation(s)
- Chen Xu
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
| | - Yanxue Ma
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
| | - Haihua Huang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China;
| | - Zheng Ruan
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China;
- Correspondence: (Z.R.); (Y.L.)
| | - Yuling Li
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
- Correspondence: (Z.R.); (Y.L.)
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5
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Adamo D, Galaverni G, Genna VG, Lococo F, Pellegrini G. The Growing Medical Need for Tracheal Replacement: Reconstructive Strategies Should Overcome Their Limits. Front Bioeng Biotechnol 2022; 10:846632. [PMID: 35646864 PMCID: PMC9132048 DOI: 10.3389/fbioe.2022.846632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Breathing, being predominantly an automatic action, is often taken for granted. However, respiratory diseases affect millions of people globally, emerging as one of the major causes of disability and death overall. Among the respiratory dysfunctions, tracheal alterations have always represented a primary challenge for clinicians, biologists, and engineers. Indeed, in the case of wide structural alterations involving more than 50% of the tracheal length in adults or 30% in children, the available medical treatments are ineffective or inapplicable. So far, a plethora of reconstructive approaches have been proposed and clinically applied to face this growing, unmet medical need. Unfortunately, none of them has become a well-established and routinely applied clinical procedure to date. This review summarizes the main clinical reconstructive attempts and classifies them as non-tissue engineering and tissue engineering strategies. The analysis of the achievements and the main difficulties that still hinder this field, together with the evaluation of the forefront preclinical experiences in tracheal repair/replacement, is functional to promote a safer and more effective clinical translation in the near future.
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Affiliation(s)
- Davide Adamo
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Galaverni
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Graziella Pellegrini
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
- Holostem Terapie Avanzate S.r.l., Modena, Italy
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6
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Samat AA, Hamid ZAA, Yahaya BH. Tissue Engineering for Tracheal Replacement: Strategies and Challenges. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022:137-163. [PMID: 35389199 DOI: 10.1007/5584_2022_707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The critical feature in trachea replacement is to provide a hollow cylindrical framework that is laterally stable and longitudinally flexible, facilitating cartilage and epithelial tissue formation. Despite advanced techniques and sources of materials used, most inherent challenges are related to the complexity of its anatomy. Limited blood supply leads to insufficient regenerative capacity for cartilage and epithelium. Natural and synthetic scaffolds, different types of cells, and growth factors are part of tissue engineering approaches with varying outcomes. Pre-vascularization remains one of the crucial factors to expedite the regenerative process in tracheal reconstruction. This review discusses the challenges and strategies used in tracheal tissue engineering, focusing on scaffold implantation in clinical and preclinical studies conducted in recent decades.
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Affiliation(s)
- Asmak Abdul Samat
- Lung Stem Cell and Gene Therapy Group, Regenerative Medicine Cluster, Advanced Medical and Dental Institute (IPPT), Universiti Sains Malaysia, Penang, Malaysia
- Fundamental Dental and Medical Sciences, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Zuratul Ain Abdul Hamid
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Penang, Malaysia
| | - Badrul Hisham Yahaya
- Lung Stem Cell and Gene Therapy Group, Regenerative Medicine Cluster, Advanced Medical and Dental Institute (IPPT), Universiti Sains Malaysia, Penang, Malaysia.
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7
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Boudreaux KA, Bui R, Horwich P, Chang BA. Serratus Anterior-Rib Composite Flap as a Novel Approach for Tracheal Reconstruction. Ann Otol Rhinol Laryngol 2022; 132:110-114. [PMID: 35156399 DOI: 10.1177/00034894211067608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report a novel case of tracheal reconstruction using a serratus anterior-rib composite flap. METHODS Case report and literature review. RESULTS A 46-year-old male with a 4 cm anterior tracheal wall defect underwent reconstruction with a serratus anterior-rib composite flap. The patient experienced excellent results regarding phonation, swallowing, and cosmesis. CONCLUSION The serratus anterior-rib composite flap appears to be a suitable candidate for tracheal reconstruction and merits further analysis in this context. The flap's intrinsic incorporation of a perfused rib segment allows for reliable reconstruction of the neotrachea and maintenance of proximal dynamic airway support.
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Affiliation(s)
- Kyle A Boudreaux
- Department of Otolaryngology/Head & Neck Surgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Roger Bui
- Department of Otolaryngology/Head & Neck Surgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Peter Horwich
- Department of Otolaryngology/Head & Neck Surgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Brent A Chang
- Department of Otolaryngology/Head & Neck Surgery, LSU Health Shreveport, Shreveport, LA, USA
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8
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Soriano L, Khalid T, Whelan D, O'Huallachain N, Redmond KC, O'Brien FJ, O'Leary C, Cryan SA. Development and clinical translation of tubular constructs for tracheal tissue engineering: a review. Eur Respir Rev 2021; 30:30/162/210154. [PMID: 34750116 DOI: 10.1183/16000617.0154-2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Effective restoration of extensive tracheal damage arising from cancer, stenosis, infection or congenital abnormalities remains an unmet clinical need in respiratory medicine. The trachea is a 10-11 cm long fibrocartilaginous tube of the lower respiratory tract, with 16-20 tracheal cartilages anterolaterally and a dynamic trachealis muscle posteriorly. Tracheal resection is commonly offered to patients suffering from short-length tracheal defects, but replacement is required when the trauma exceeds 50% of total length of the trachea in adults and 30% in children. Recently, tissue engineering (TE) has shown promise to fabricate biocompatible tissue-engineered tracheal implants for tracheal replacement and regeneration. However, its widespread use is hampered by inadequate re-epithelialisation, poor mechanical properties, insufficient revascularisation and unsatisfactory durability, leading to little success in the clinical use of tissue-engineered tracheal implants to date. Here, we describe in detail the historical attempts and the lessons learned for tracheal TE approaches by contextualising the clinical needs and essential requirements for a functional tracheal graft. TE manufacturing approaches explored to date and the clinical translation of both TE and non-TE strategies for tracheal regeneration are summarised to fully understand the big picture of tracheal TE and its impact on clinical treatment of extensive tracheal defects.
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Affiliation(s)
- Luis Soriano
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Joint first authors
| | - Tehreem Khalid
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Joint first authors
| | - Derek Whelan
- Dept of Mechanical, Biomedical and Manufacturing Engineering, Munster Technological University, Cork, Ireland
| | - Niall O'Huallachain
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen C Redmond
- National Cardio-thoracic Transplant Unit, Mater Misericordiae University Hospital and UCD School of Medicine, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Cian O'Leary
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Both authors contributed equally
| | - Sally-Ann Cryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland .,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Both authors contributed equally
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Huang HF, Hwang JJ, Huang PM. Tracheal reconstruction with nail grafts: A novel approach. JTCVS Tech 2021; 10:554-560. [PMID: 34984402 PMCID: PMC8691915 DOI: 10.1016/j.xjtc.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Methods Results Conclusions
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Tiwari Y, Krishnamurthy A. Long-term outcomes of differentiated thyroid cancers with tracheal invasion: A 15-year experience. Indian J Cancer 2020; 57:398-404. [PMID: 32675437 DOI: 10.4103/ijc.ijc_456_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tracheal invasion is reported to occur in approximately one-third of the patients of locally advanced thyroid cancers. There is a paucity of data in literature with regard to the long-term outcomes of thyroid cancers with tracheal invasion. METHODS A total of 37 patients from our tertiary care center underwent radical surgery for tracheal involvement for differentiated thyroid cancers between the years 2002 and 2016. The variables pertaining to the demographics, clinical presentation, imaging, operative details and histopathology reports were captured from the patient's case records and analyzed. RESULTS Among the 37 patients, there were 21 males and 16 females. Majority of the patients (56.8%) were >55 years of age. Surgery (tracheal resection) was performed in the primary setting in 29 patients, whereas it was performed in a recurrent setting in 8 patients. As per the Shin classification, 3 patients belonged to Shin stage 1, 3 to Shin stage 2, 16 patients to Shin stage 3 and 15 patients to Shin stage 4. There was no 30 day postoperative mortality in our cohort. The median follow-up of our cohort was 175 months. The 5-, 10-, and the 15-year overall survivals of the entire cohort were 81.7%, 47.8%, and 35.9%, respectively. CONCLUSION Our series shows favorable long-term oncological outcomes of selected patients of thyroid cancers with tracheal resection and adds to the limited long-term data available in literature.
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Affiliation(s)
- Yogesh Tiwari
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Delaere PR, Van Raemdonck D. Commentary: The sobering truth about tracheal regeneration. J Thorac Cardiovasc Surg 2020; 159:2537-2539. [DOI: 10.1016/j.jtcvs.2019.10.116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
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12
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Boada M, Guzmán R, Sandoval E. Long tracheal replacement or the philosopher's stone. Ann Cardiothorac Surg 2020; 9:58-59. [PMID: 32175243 DOI: 10.21037/acs.2019.11.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marc Boada
- Department of Thoracic Surgery, ICR, Hospital Clínic, Barcelona, Spain
| | - Rudith Guzmán
- Department of Thoracic Surgery, ICR, Hospital Clínic, Barcelona, Spain
| | - Elena Sandoval
- Department of Cardiovascular Surgery, ICCV, Hospital Clínic, Barcelona, Spain
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Fast cyclical-decellularized trachea as a natural 3D scaffold for organ engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 105:110142. [DOI: 10.1016/j.msec.2019.110142] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 08/15/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
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Abstract
RATIONALE Primary end-to-end anastomosis is common in adult trachea resection. Nevertheless, considering that the utilization of grafts is still essential for restoring defect in long-segment tracheal resection surgery, long-segment tracheal resection and reconstruction still remain challenging. Herein we present a novel case in which we resected a large tracheal mass and reconstructed the long-segment defect through using a thyroid-pericardium flap, which has not been reported yet. PATIENT CONCERNS A 35-year old male patient was admitted due to 'Repeated dry cough for 2 years, shortness of breath after activities for 1 month'. Patient had no other obvious symptoms. DIAGNOSES CT revealed that a large neoplasm was located in the cervical trachea and the pedicle was in the tracheal membrane, with total length of approximately 6 cm. Positron emission tomography computed tomography demonstrated an abnormally elevated levels of glucose metabolism in the upper part of the posterior tracheal wall. Therefore, this lesion was primarily considered as a malignancy. INTERVENTIONS The patient was performed by a primary resection of long-segment tracheal mass followed by thyroid-pericardium composite tissue flap for reconstruction. OUTCOME The operation was successful, without hydrops or pneumatosis in the mediastinum. One week postoperatively, CT showed that there was no pneumomediastinum and mediastinal abscess. Three weeks postoperatively, fiber bronchoscope showed the flap with normal color and the unobstructed tracheal cavity. The patient healed without complication. LESSONS The thyroid-pericardium flap is a convenient, secure, and effective material for long-segment trachea mass resection and reconstruction.
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Jang SJ, Park MH, Lee TK, Choi SH. Healing Effect of Platelet-rich Plasma on Decellularized Tracheal Allotransplantation in Rabbits. In Vivo 2018; 32:1443-1447. [PMID: 30348699 DOI: 10.21873/invivo.11397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/19/2018] [Accepted: 09/21/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND/AIM The purpose of this study was to explore the effect of platelet-rich plasma (PRP) on enhancing healing of trachea allotransplantation and confirm the effect via parallel histological and tracheoscopic examinations in seven adult New Zealand White rabbits. MATERIALS AND METHODS Harvested trachea was inserted into recipients with end-to-end anastomosis by a simple interrupted suture. PRP-treated rabbits were treated with 0.5 ml of PRP at the trachea grafts, while control rabbit allografts were treated with 0.5 ml of saline. RESULTS Tracheoscopy of tracheal allografts treated with PRP revealed that the trachea was well healed with no stenosis. The healing effect in the PRP-treated rabbits increased tracheal activity and produced faster trachea regeneration compared to that in control rabbits. There was a good correlation between the subjective symptom of noisy breathing and the objective grading of tracheal stenosis. The tracheal allografts with suture materials appeared slightly pale and looked more like mucosa erosion than normal mucosa at four weeks post-surgery. Contact of trachea-to-transplanted grafts in PRP-treated rabbits was intimate with the surface of the transplanted region and showed high-density epithelialization. After 8 weeks, blood vessels were observed in the transplanted graft in PRP-treated rabbits. Normal epithelium was present in grafts at 8 weeks after allotransplantation. No CD20+ cells were detected in grafts but a few CD3+ cells were observed under the epithelium. CONCLUSION The results of this study show that it is possible to perform tracheal reconstruction in rabbits treated with PRP after tracheal transplantation.
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Affiliation(s)
- Seok Jin Jang
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Min-Ho Park
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Tae-Ki Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Seok Hwa Choi
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
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