Abstract
Background Trachea reconstruction requires creation of a functional lining, semirigid support,
and vascularity. We aimed to design composite flaps with these three components in
a rabbit model.
Methods Circumferential (n = 9) and partial anterior (n = 8) tracheal defects were created in rabbits. A circumferential defect was reconstructed
with a tubed ear flap incorporating cartilage for support and skin for lining. This
was pedicled on the posterior auricular vessels and tunneled into the neck to bridge
the defect. In the second experiment, a longitudinal anterior trachea defect was patched
with a pedicled rib cartilage and intercostal muscle flap based on the internal mammary
vessels. The vascularized fascia over the intercostal muscles replaced the lining
while the cartilage provided support. Postoperatively, the rabbits were monitored
clinically and endoscopically. The tracheal constructs were examined histologically
after the animals were sacrificed.
Results Rabbits with circumferential defects reconstructed with the ear flap survived up
to 6 months. Histology demonstrated vascularized cartilage with good integration of
the flap with native trachea. However, hair growth and skin desquamation resulted
in airway obstruction in the long term. In the second experiment, all the rabbits
survived without respiratory distress, and the intercostal muscle fascia was completely
covered by native respiratory epithelium.
Conclusion We described two experimental techniques using autologous composite flaps for single-stage
trachea reconstruction in a rabbit model. Skin was a poor lining replacement, whereas
vascularized muscle fascia became covered with respiratory epithelium. A rib cartilage
and muscle flap could potentially be used for reconstruction of partial defects in
humans.
Keywords
trachea - reconstruction - rabbit
