Large animal models for long-segment tracheal reconstruction: a systematic review
| Autor: | Bien-Keem Tan, Cindy Siaw-Lin Goh, Janna-Vale Joethy, Manzhi Wong |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Vascular pedicle business.industry medicine.medical_treatment respiratory system 030204 cardiovascular system & hematology Long segment Surgery Trachea 03 medical and health sciences 0302 clinical medicine Vascularity 030220 oncology & carcinogenesis Models Animal medicine Animals Optimal combination medicine.symptom business Large animal Graft preservation Allotransplantation Systematic search |
| Zdroj: | Journal of Surgical Research. 231:140-153 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2018.05.025 |
| Popis: | Background The reconstruction of extensive tracheal defects is an unresolved problem. Despite decades of research, a reliable and practical substitute remains to be found. While there have been clinical reports of successful long-segment tracheal reconstruction, reproducibility and widespread applicability of these techniques have yet to be achieved. Large animals such as the dog, pig, sheep, and goat have comparable tracheal morphology and physiology to humans making them useful preclinical models to screen potential therapeutic strategies. Materials and methods The literature was reviewed to identify large animal models commonly used for tracheal reconstruction. A systematic search of PubMed and EMBASE was performed for large animal studies reporting on the reconstruction of long-segment tracheal and carinal defects. Fifty-seven studies were identified for analysis. Results There is no standard large animal model available for tracheal research. In recent years, livestock species have gained favor over dogs as animal models in this field. The minimum requirements for successful tracheal replacement are rigidity, vascularity, and epithelial lining. Early attempts with synthetic prostheses were met with disappointing results. An autologous tracheal substitute is ideal but hindered by limited donor site availability and the lack of a dominant vascular pedicle for microsurgical reconstruction. Although tracheal allotransplantation enables like-for-like replacement, there are unresolved issues relating to graft vascularity, immunosuppression, and graft preservation. Tissue engineering holds great promise; however, the optimal combination of scaffold, cells, and culture conditions is still indeterminate. Conclusions Despite impressive advances in tracheal reconstruction, a durable substitute for extended tracheal defects continues to be elusive. |
| Databáze: | OpenAIRE |
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