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Tracheal reconstruction with a free vascularized myofascial flap: preclinical investigation in a porcine model to human clinical application

Although there are various methods for tracheal reconstruction, such as a simple approximation with suturing and coverage with adjacent soft tissue or muscle, large defects >50% of the tracheal length still present a clinical challenge. Tissue engineering, a recent promising way to possibly resol...

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Detalles Bibliográficos
Autores principales: Kim, Won Shik, Chang, Jae Won, Jang, Woo Soon, Seo, Young Joon, Kang, Mi-Lan, Sung, Hak-Joon, Kim, Da Hee, Kim, Jung Min, Park, Jae Hong, Ban, Myung Jin, Na, Gina, Shin, Seung Ho, Byeon, Hyung Kwon, Koh, Yoon Woo, Kim, Se-Heon, Baik, Hong Koo, Choi, Eun Chang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577286/
https://www.ncbi.nlm.nih.gov/pubmed/28855683
http://dx.doi.org/10.1038/s41598-017-10733-z
Descripción
Sumario:Although there are various methods for tracheal reconstruction, such as a simple approximation with suturing and coverage with adjacent soft tissue or muscle, large defects >50% of the tracheal length still present a clinical challenge. Tissue engineering, a recent promising way to possibly resolve this problem, requires a long preparatory period for stem cell seeding on a scaffold and relatively invasive procedures for stem cell harvesting. As an alternative, we used a vascularized myofascial flap for tracheal reconstruction. In four porcine models, the deep inferior epigastric perforator (DIEP) was used in two and the superior epigastric artery perforator (SEAP) in two. Transformation of the surface of the transplanted myofascial flap was analyzed in the airway environment. The flaps failed in the DIEP group due to venous congestion. At 12 weeks postoperatively, none of SEAP group showed any signs of respiratory distress; the inner surface of the implant exhibited stratified squamous epithelium with sparse cilia. In the clinical setting, a patient who underwent a tracheal reconstruction with a vascularized myofascial flap and 2-year follow-up was in good health with no respiratory distress symptoms.