Reconstruction of the Trachea

Abstract

This article reviews established methods of autologous tracheal reconstruction, the various synthetic prostheses that have been used in clinical practice, and briefly describes the latest developments in stem cell tracheal bioengineering and allogeneic tracheal transplantation. Reconstruction of the trachea is challenging due to its part cervical part thoracic location, proximity to major vessels, variable blood supply, and its constant colonization with bacteria. In cases of limited resection, primary anastomosis, autologous patch grafts, local advancement rotation flaps, and locoregional cutaneous and muscle flaps will often suffice. In more extensive resections, complex composite microsurgical reconstruction with a radial forearm free flap with cartilage grafts for skeletal support has proven to be viable and reliable. Synthetic tracheal prostheses, solid as well as porous, have been trialed with disappointing results. Infection, dislodgement, migration, and obstruction are not uncommon. Reconstruction with the cadaveric tracheal allografts and aortic allografts continue to be fraught with complications, specifically graft infections. Tracheal bioengineering and tracheal allotransplantation have emerged relatively recently. Despite early promising results, long-term outcome data on these new techniques are still lacking.

Keywords

trachea - autologous - prosthesis - bioengineering - transplantation

• References

• 1 Belsey R. Resection and reconstruction of the intrathoracic trachea. Br J Surg 1950; 38 (150) 200-205
• 2 Sykes M. Immune evasion by chimeric trachea. N Engl J Med 2010; 362 (2) 172-174
• 3 Birchall M, Macchiarini P. Airway transplantation: a debate worth having?. Transplantation 2008; 85 (8) 1075-1080
• 4 Marchant W. Anatomy of the larynx, trachea, and bronchi. Anaesth Intensive Care Med 2005; 6: 253-255
• 5 Ellis H, Feldman S, Harrop-Griffiths W. Anatomy for Anaesthetists. 8th ed. Massachusetts: Blackwell Publishing; 2004
• 6 Pinsonneault C, Fortier J, Donati F. Tracheal resection and reconstruction. Can J Anaesth 1999; 46 (5 Pt 1) 439-455
• 7 Roman PE, Battafarano RJ, Grigore AM. Anesthesia for tracheal reconstruction and transplantation. Curr Opin Anaesthesiol 2013; 26 (1) 1-5
• 8 Macfie A, Hawthorne C. Anesthesia for surgery of the trachea and main bronchi. Anaesth Intensive Care Med 2011; 12 (12) 558-562
• 9 Sandberg W. Anesthesia and airway management for tracheal resection and reconstruction. Int Anesthesiol Clin 2000; 38 (1) 55-75
• 10 Hobai IA, Chhangani SV, Alfille PH. Anesthesia for tracheal resection and reconstruction. Anesthesiol Clin 2012; 30 (4) 709-730
• 11 Ch'ng S, Palme CE, Wong GL , et al. Reconstruction of the (Crico)trachea for malignancy in the virgin and irradiated neck. J Plast Reconstr Aesthet Surg 2012; 65 (12) 1645-1653
• 12 Grillo HC. Development of tracheal surgery: a historical review. Part 1: techniques of tracheal surgery. Ann Thorac Surg 2003; 75 (2) 610-619
• 13 Grillo H. Surgery of the Trachea and Bronchi. Hamilton, Ontario, Canada: BC Decker; 2004
• 14 Montgomery WW. Suprahyoid release for tracheal anastomosis. Arch Otolaryngol 1974; 99 (4) 255-260
• 15 Grillo HC. Reconstruction of the trachea. Experience in 100 consecutive cases. Thorax 1973; 28 (6) 667-679
• 16 Kucera KA, Doss AE, Dunn SS, Clemson LA, Zwischenberger JB. Tracheal replacements: part 1. ASAIO J 2007; 53 (4) 497-505
• 17 Edgerton MT, Zovickian A. Reconstruction of the trachea and infraglottic larynx. Plast Reconstr Surg (1946) 1954; 13 (3) 167-192
• 18 Bryant LR. Replacement of tracheobronchial defects with autogenous pericardium. J Thorac Cardiovasc Surg 1964; 48: 733-740
• 19 Cheng AT, Backer CL, Holinger LD, Dunham ME, Mavroudis C, Gonzalez-Crussi F. Histopathologic changes after pericardial patch tracheoplasty. Arch Otolaryngol Head Neck Surg 1997; 123 (10) 1069-1072
• 20 Narodick BG, Worman LW, Pemberton AH. Relaxation technique for tracheal reconstruction. Ann Thorac Surg 1965; 24: 190-196
• 21 Fonkalsrud EW, Plested WG. Tracheobronchial reconstruction with autologous periosteum. J Thorac Cardiovasc Surg 1966; 52 (5) 666-674
• 22 Cohen RC, Filler RM, Konuma K, Bahoric A, Kent G, Smith C. A new model of tracheal stenosis and its repair with free periosteal grafts. J Thorac Cardiovasc Surg 1986; 92 (2) 296-304
• 23 Bailey BJ, Kosoy J. Observations in the development of tracheal prostheses and tracheal transplantation. Laryngoscope 1970; 80 (10) 1553-1565
• 24 Jones RE, Morgan RF, Marcella KL, Mills SE, Kron IL. Tracheal reconstruction with autogenous jejunal microsurgical transfer. Ann Thorac Surg 1986; 41 (6) 636-638
• 25 Ohlsén L, Nordin U. Tracheal reconstruction with perichondrial grafts. Scand J Plast Reconstr Surg 1976; 10 (2) 135-145
• 26 Azorin JF, Bertin F, Martinod E, Laskar M. Tracheal replacement with an aortic autograft. Eur J Cardiothorac Surg 2006; 29 (2) 261-263
• 27 Panje WR, Herberhold C , eds. Head and Neck Surgery, vol 3. New York, NY: Thieme Medical Publishers; 1995
• 28 Ris HB, Krueger T, Cheng C, Pasche P, Monnier P, Magnusson L. Tracheo-carinal reconstructions using extrathoracic muscle flaps. Eur J Cardiothorac Surg 2008; 33 (2) 276-283
• 29 Iyer NG, Clark JR, Ashford BG. Internal mammary artery perforator flap for head and neck reconstruction. ANZ J Surg 2009; 79 (11) 799-803
• 30 Shinohara H, Yuzuriha S, Matsuo K, Kushima H, Kondoh S. Tracheal reconstruction with a prefabricated deltopectoral flap combined with costal cartilage graft and palatal mucosal graft. Ann Plast Surg 2004; 53 (3) 278-281
• 31 Yu P, Clayman GL, Walsh GL. Long-term outcomes of microsurgical reconstruction for large tracheal defects. Cancer 2011; 117 (4) 802-808
• 32 Fujiwara T, Nishino K, Numajiri T. Tracheal reconstruction with a prefabricated and double-folded radial forearm free flap. J Plast Reconstr Aesthet Surg 2009; 62 (6) 790-794
• 33 Kashiwa K, Kobayashi S, Tono H, Nohara T, Honda T, Sakurai S. Reconstruction of the cervical trachea using a prefabricated corticoperiosteal flap from the femur. Ann Plast Surg 2009; 62 (6) 633-636
• 34 Teng MS, Malkin BD, Urken ML. Prefabricated composite free flaps for tracheal reconstruction: a new technique. Ann Otol Rhinol Laryngol 2005; 114 (11) 822-826
• 35 Olias J, Millán G, da Costa D. Circumferential tracheal reconstruction for the functional treatment of airway compromise. Laryngoscope 2005; 115 (1) 159-161
• 36 Zur KB, Urken ML. Vascularized hemitracheal autograft for laryngotracheal reconstruction: a new surgical technique based on the thyroid gland as a vascular carrier. Laryngoscope 2003; 113 (9) 1494-1498
• 37 Grillo HC. Tracheal replacement: a critical review. Ann Thorac Surg 2002; 73 (6) 1995-2004
• 38 Doss AE, Dunn SS, Kucera KA, Clemson LA, Zwischenberger JB. Tracheal replacements: Part 2. ASAIO J 2007; 53 (5) 631-639
• 39 Beattie Jr EJ, Blades B, Keshishian JM. Tracheal reconstruction. J Thorac Surg 1956; 32 (6) 707-725 , discussion, 725–727
• 40 Jarvis FJ. Pulmonary resection in the treatment of pulmonary tuberculosis. A study of 100 consecutive cases. West J Surg Obstet Gynecol 1950; 58 (11) 643-647
• 41 Cotton BH, Hills B, Penido JR. Resection of the trachea for carcinoma; report of two cases. J Thorac Surg 1952; 24 (3) 231-245
• 42 Toomes H, Mickisch G, Vogt-Moykopf I. Experiences with prosthetic reconstruction of the trachea and bifurcation. Thorax 1985; 40 (1) 32-37
• 43 Neville WE, Bolanowski JP, Kotia GG. Clinical experience with the silicone tracheal prosthesis. J Thorac Cardiovasc Surg 1990; 99 (4) 604-612 , discussion 612–613
• 44 Kramish D, Morfit HM. The use of a Teflon prosthesis to bridge complete sleeve defects in the human trachea. Am J Surg 1963; 106: 704-708
• 45 Ekestrom S, Carlens E. Teflon prosthesis in tracheal defects in man. Acta Chir Scand Suppl 1959; (245) 71-75
• 46 McCall JW, Whitaker CW. The use of prostheses in the larynx and trachea. A preliminary report. Trans Am Laryngol Assoc 1962; 83: 16-24
• 47 Longmire Jr WP. The repair of large defects of the trachea. Ann Otol Rhinol Laryngol 1948; 57 (3) 875-883
• 48 Rich JT, Gullane PJ. Current concepts in tracheal reconstruction. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (4) 246-253
• 49 Scherer MA, Ascherl R, Geissdörfer K , et al. Experimental bioprosthetic reconstruction of the trachea. Arch Otorhinolaryngol 1986; 243 (4) 215-223
• 50 Cahan WG. Carcinoma of intrathoracic trachea: excision and repair by tantalum gauze-fascia lata graft; report of a case. J Thorac Surg 1952; 23 (5) 513-527
• 51 Yeh TJ, Batayias G, Peters H, Ellison RG. Metastatic carcinoma to the trachea: report of a case of palliation by resection and Marlex graft. J Thorac Cardiovasc Surg 1965; 49: 886-892
• 52 Moghissi K. Reconstruction of trachea with Marlex mesh pericardium following circumferential excision. J R Coll Surg Edinb 1975; 20 (5) 327-331
• 53 Pearson FG, Henderson RD, Gross AE, Ginsberg RJ, Stone RM. The reconstruction of circumferential tracheal defects with a porous prosthesis. An experimental and clinical study using heavy Marlex mesh. J Thorac Cardiovasc Surg 1968; 55 (5) 605-616
• 54 Nelson RJ, Goldberg L, White RA, Shors E, Hirose FM. Neovascularity of a tracheal prosthesis/tissue complex. J Thorac Cardiovasc Surg 1983; 86 (6) 800-808
• 55 Grillo HC. Surgery of the trachea. Curr Probl Surg 1970; (Jul) 3-59
• 56 Propst EJ, Prager JD, Meinzen-Derr J, Clark SL, Cotton RT, Rutter MJ. Pediatric tracheal reconstruction using cadaveric homograft. Arch Otolaryngol Head Neck Surg 2011; 137 (6) 583-590
• 57 Jacobs JP, Quintessenza JA, Andrews T , et al. Tracheal allograft reconstruction: the total North American and worldwide pediatric experiences. Ann Thorac Surg 1999; 68 (3) 1043-1051 , discussion 1052
• 58 Wurtz A, Porte H, Conti M , et al. Surgical technique and results of tracheal and carinal replacement with aortic allografts for salivary gland-type carcinoma. J Thorac Cardiovasc Surg 2010; 140 (2) 387-393 , e2
• 59 Macchiarini P, Jungebluth P, Go T , et al. Clinical transplantation of a tissue-engineered airway. Lancet 2008; 372 (9655) 2023-2030
• 60 Delaere P, Vranckx J, Verleden G, De Leyn P, Van Raemdonck D . Leuven Tracheal Transplant Group. Tracheal allotransplantation after withdrawal of immunosuppressive therapy. N Engl J Med 2010; 362 (2) 138-145
• 61 Vogel G. Trachea transplants test the limits. Science 2013; 340 (6130) 266-268
• 62 Jungebluth P, Alici E, Baiguera S , et al. Tracheobronchial transplantation with a stem-cell-seeded bioartificial nanocomposite: a proof-of-concept study. Lancet 2011; 378 (9808) 1997-2004
• 63 Rose KG, Sesterhenn K, Wustrow F. Tracheal allotransplantation in man. Lancet 1979; 1 (8113) 433
• 64 Levashov YuN, Yablonsky PK, Cherny SM, Orlov SV, Shafirovsky BB, Kuznetzov IM. One-stage allotransplantation of thoracic segment of the trachea in a patient with idiopathic fibrosing mediastinitis and marked tracheal stenosis. Eur J Cardiothorac Surg 1993; 7 (7) 383-386
• 65 Klepetko W, Marta GM, Wisser W , et al. Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft. J Thorac Cardiovasc Surg 2004; 127 (3) 862-867
• 66 Elliott MJ, De Coppi P, Speggiorin S , et al. Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study. Lancet 2012; 380 (9846) 994-1000