Abstract
Reconstruction of long-segment tracheal stenosis remains problematic. Ex vivo transplantation of stem cell-derived tracheas has been established in humans using external tissue bioreactors. These bioreactors, however, are not widely accessible. Thus, we are developing a rotational flap-based “internal bioreactor” to allow in vivo stem cell engraftment in a pre-vascularized recipient bed. This muscle will also then serve as a carrier for the transplanted trachea during rotation into position for airway reconstruction. Herein, we present a study investigating the feasibility of two pedicle muscle flaps for implantation and subsequent tracheal transplantation. Trapezius and latissimus flaps were raised using established surgical techniques. The length and width of each flap, along with the distance from the pedicle takeoff to the trachea, were measured. The overall ability of the flaps to reach the trachea was assessed. Twelve flaps were raised in 5 fresh adult human cadavers. For the trapezius flap, averages were: flap length of 16.4 cm, flap width of 5.95 cm at the tip, and distance from the pedicle takeoff to the trachea of 11.1 cm. For the latissimus dorsi flap, averages were: flap length of 35.4 cm, flap width of 7.25 cm at the tip, and distance from the pedicle takeoff to the trachea of 27.3 cm. All flaps showed sufficient durability and rotational ability. Our results show that both trapezius and latissimus dorsi flaps can be transposed into the neck to allow tension-free closure of tracheal defects. For cervical tracheal transplantation, both flaps are equally adequate. We believe that trapezius and latissimus dorsi muscle flaps are potential tracheal implantation beds in terms of vascular supply, durability, and rotational ability.
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References
Baiguera S, Birchall MA, Macchiarini P (2010) Tissue-engineered tracheal transplantation. Transplantation 89:485–491
Kucera KA, Doss AE, Dunn SS, Clemson LA, Zwischenberger JB (2007) Tracheal replacements: part 1. ASAIO J 53:497–505
Walles T (2011) Tracheobronchial bio-engineering: biotechnology fulfilling unmet medical needs. Adv Drug Deliv Rev 63:367–374
Macchiarini P (1998) Tracheal transplantation: beyond the replacement of a simple conduit. Eur J Cardiothorac Surg 14:621–623
Propst EJ, Prager JD, Meinzen-Derr J, Clark SL, Cotton RT, Rutter MJ (2011) Pediatric tracheal reconstruction using cadaveric homograft. Arch Otolaryngol Head Neck Surg 137:583–590
Yener M, Acar GO, Cansiz H, Oz B, Cigerciogullari E, Seymen O (2010) Use of titanium mesh in laryngotracheal reconstruction: an experimental study on rabbits. Eur Arch Otorhinolaryngol 267:1247–1253
Merati AL, Rieder AA, Patel N, Park DL, Girod D (2005) Does successful segmental tracheal resection require releasing maneuvers? Otolaryngol Head Neck Surg 133:372–376
Mulliken JB, Grillo HC (1968) The limits of tracheal resection with primary anastomosis: further anatomical studies in man. J Thorac Cardiovasc Surg 55:418–421
Rosen FS, Pou AM, Buford WL (2003) Tracheal resection with primary anastomosis in cadavers: the effects of releasing maneuvers and length of tracheal resection on tension. Ann Otol Rhinol Laryngol 112:869–876
Grillo HC (2002) Tracheal replacement: a critical review. Ann Thorac Surg 73:1995–2004
ten Hallers EJO, Rakhorst G, Marres HAM, Jansen JA, van Kooten TG, Schutte HK, van Loon JP, van der Houwen EB, Verkerke GJ (2004) Animal models for tracheal research. Biomaterials 25:1533–1543
Doss AE, Dunn SS, Kucera KA, Clemson LA, Zwischenberger JB (2007) Tracheal replacements: part 2. ASAIO J 53:631–639
Nakamura T, Ohmori K, Kanemaru S (2011) Tissue-engineered airway and “in situ tissue engineering”. Gen Thorac Cardiovasc Surg 59:91–97
Macchiarini P (2004) Trachea-guided generation: deja vu all over again? J Thorac Cardiovasc Surg 128:14–16
Macchiarini P, Jungebluth P, Go T, Asnaghi MA, Rees LE, Cogan TA, Dodson A, Martorell J, Bellini S, Parnigotto PP et al (2008) Clinical transplantation of a tissue-engineered airway. Lancet 372:2023–2030
Delaere P, Vranckx J, Verleden G, De Leyn P, Van Raemdonck D (2010) Tracheal allotransplantation after withdrawal of immunosuppressive therapy. N Engl J Med 362:138–145
Klepetko W, Marta GM, Wisser W, Melis E, Kocher A, Seebacher G, Aigner C, Mazhar S (2004) Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft. J Thorac Cardiovasc Surg 127:862–867
Remlinger NT, Czajka CA, Juhas ME, Vorp DA, Stolz DB, Badylak SF, Gilbert S, Gilbert TW (2010) Hydrated xenogeneic decellularized tracheal matrix as a scaffold for tracheal reconstruction. Biomaterials 31:3520–3526
Delaere PR, Liu Z, Hermans R (1998) Laryngotracheal reconstruction with tracheal patch allografts. Laryngoscope 108:273–279
Urken M (1995) Trapezius system., Atlas of regional and free flaps for head and neck reconstructionRaven Press, New York
Urken M, Sullivan M (1995) Latissimus Dorsi., Atlas of regional and free flaps for head and neck reconstructionRaven Press, New York
Rasband W (1997–2012) US National Institutes of Health, vol 2012
Yang D, Morris SF (1998) Trapezius muscle: anatomic basis for flap design. Ann Plast Surg 41:52–57
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This paper was presented in part at the Georgia Society of Otolaryngology and Metro Atlanta Educational Society for Otolaryngology; Greensboro, GA, USA; December 4, 2011.
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Jana, T., Khabbaz, E., Bush, C.M. et al. The body as a living bioreactor: a feasibility study of pedicle flaps for tracheal transplantation. Eur Arch Otorhinolaryngol 270, 181–186 (2013). https://doi.org/10.1007/s00405-012-2105-5
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DOI: https://doi.org/10.1007/s00405-012-2105-5