Successful Tracheal Replacement in Humans Using Autologous Tissues: An 8-Year Experience
| Autor: | Elie Fadel, Frédéric Kolb, Olaf Mercier, Thierry Le Chevalier, Philippe Dartevelle, Dominique Fabre, Sacha Mussot |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Mucociliary clearance medicine.medical_treatment Transplantation Autologous Surgical Flaps Tracheotomy Tracheal Neoplasm medicine Humans Aged Retrospective Studies medicine.diagnostic_test Respiratory distress business.industry Stent Middle Aged Otorhinolaryngologic Surgical Procedures Endoscopy Surgery Trachea medicine.anatomical_structure Female Tracheal Neoplasms Cardiology and Cardiovascular Medicine Airway business Subcutaneous tissue |
| Zdroj: | The Annals of Thoracic Surgery. 96:1146-1155 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2013.05.073 |
| Popis: | Background Fifty years of surgical research using synthetic materials and heterologous tissues failed to find a good, durable replacement for the trachea. We investigated autologous tracheal substitution (ATS) without synthetic material or immunosuppression. Methods For ATS, we used a single-stage operation to construct a tube from a forearm free fasciocutaneous flap vascularized by radial vessels that was reanastomosed to internal mammary vessels and reinforced by rib cartilages interposed transversally in the subcutaneous tissue. Tracheal resections 7 to 12 cm long (mean, 11 cm) were done to treat 8 primary tracheal neoplasms, including 5 adenoid cystic carcinomas (ACC) and 3 squamous cell carcinomas (SCC); 3 secondary tracheal neoplasms, including 1 thyroid carcinomas and 2 lymphomas; and 1 postintubation tracheal destruction after a long history of stenting. Transitory tracheotomy was associated to the absence of mucociliary clearance. Results ATS has been performed in 12 patients since 2004, with additional resections in 4 patients, comprising 1 carinal resection alone, 1 associated with lobectomy, and 2 pharyngolaryngectomies. All patients were extubated on postoperative day 1. Eight patients are alive at a mean of 36 months (range, 2 to 94 months) postoperatively, with no respiratory distress. The 2 patients with ATS and carinal resections died of pulmonary infection. No airway collapse has been detected by endoscopy, dynamic computed tomography scan, or spirometry. Two patients still have a tracheotomy because the procedure was performed too low at the level of the proximal anastomosis. One patient with a chronic severe respiratory insufficiency recently required a distal, short stent. Conclusions ATS is a good, durable, tracheal substitution that resists respiratory pressure variations because of transverse rigidity, without any immunosuppression. |
| Databáze: | OpenAIRE |
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