New material for a prosthesis used in tracheal reconstruction

Tracheal replacement: a critical review

This review discusses the need for tracheal replacement, distinct from resection with primary anastomosis, the requirements for replacement, and the many efforts over the past century to accomplish this goal experimentally and clinically. Approaches have included use of foreign materials, nonviable tissue, autogenous tissue, tissue engineering, and transplantation. Biological problems in each category are noted.

Prosthetic replacement of large defects of the cervical trachea in dogs

Surgical resection and replacement of a segment of the cervical trachea was performed in 8 mongrel dogs. The replacement was with a porous prosthesis made of Dacron cloth mesh stiffened with a heat-curing polyetherurethane. Ten tracheal rings were resected in each animal to create a complete circumferential defect of the trachea measuring 7 or 8 cm in length depending on the size of the dog. Animals were sacrificed periodically from 3 to 27 months post-reconstruction. The luminal surfaces of the reconstructed tracheae showed respiratory epithelium.

Primary carcinoma of the trachea

Five cases of primary carcinoma of the trachea are summarized together with a review of 97 cases recorded at the Birmingham Cancer Registry between 1957 and 1974. Squamous cell carcinoma is the most frequent type (46.4%) followed by anaplastic and oat cell carcinoma (18.5%). The annual incidence rate is 0.15 per 100 000 in males and 0.06 per 100 000 in females. The mean age at presentation is 60.08 years and 63.89 years for males and females respectively. Although there has been an increase in the number of cases reported over this period, the increase in larynx (43%) and trachea (50%) has not kept pace with that for bronchial carcinoma (85%). Some experimental studies in animals and the results of treatment in 97 cases from the Cancer Registry are reported. A brief summary of methods of treatment for carcinoma of the trachea is included. In suitable cases, primary surgery with direct anastomosis offers the best survival rates, although the overall survival rate is poor.

[Alloplastic tracheal prosthesis with biocarbone. A study of animal experiments (author's transl)]

Animal experiments have shown bicarbone to be a suitable material for alloplastic tracheal replacement. So far survival rates have been limited by connective tissue stenoses and by loosening prostheses. Although the transplants are not lined by bronchial mucosa, the movement of secretions is not seriously impaired due to the smooth surface. It is still a matter of speculation as to whether modifying the suture technique with a more elastic transistion from the trachea to the prosthesis would produce better results.