Tracheal reconstruction with nail grafts: A novel approach

BACKGROUND: The replacement of tracheal defects has been a challenge for investigators worldwide. We aimed to develop autologous nail grafts for the reconstruction of anterior tracheal defects. METHODS: Toenail grafts were implanted to improve the structural integrity of the trachea in patients with tracheal diseases. We clinically applied these grafts for the partial replacement of the cervical tracheal cartilage. Data on graft construction details, clinical outcomes, bronchoscopy, and 3-dimensional computed tomography examinations were collected. RESULTS: The nail grafts were implanted in 4 patients. The trachea was successfully reconstructed in all cases. Bronchoscopy was performed 3 times to document healing: immediately, 1 month, and 3 months after surgery. All grafts were well vascularized and incorporated into the tracheal wall and were covered with the respiratory mucosa. Three of the patients survived during the study period, but 1 patient died of progressive lung cancer. CONCLUSIONS: Toenail grafts potentially may be used as an alternative strategy for the closure of small defects during tracheal reconstruction.