A Novel Technique of Tracheal Reconstruction with Autologous Bronchial Pedicle Flap

Abstract

We describe a technique used in 2 patients for resection of a bronchogenic carcinoma arising from the right main bronchus and extending along the lateral wall of the lower trachea without carinal invasion. A right pneumonectomy was performed in the first case, and lower and middle lobes were preserved in the second case after extended upper lobe resection. A flap was mobilized from the non-involved left lateral wall of the right main bronchus, which was left attached to the carina. This was used to close the defect in the lower trachea. An autologous bronchial pedicle flap provides reliable material to repair and reconstruct a massive central airway defect.

Tracheal reconstruction using chondrocytes seeded on a poly(l-lactic-co-glycolic acid)-fibrin/hyaluronan

“…Total resection of pathologic trachea followed by end‐to‐end anastomosis is the favored treatment; however, the total resectable length cannot exceed 30% of the trachea in children or 6 cm in adults . In addition, if indicated, reconstruction with various cartilage substitutions, such as costal cartilage, buccal mucosa, or artificial materials, has been performed after partial tracheal resection with limited success …”

“…6 In addition, if indicated, reconstruction with various cartilage substitutions, such as costal cartilage, buccal mucosa, or artificial materials, has been performed after partial tracheal resection with limited success. 7 There is no ideal substitute of tracheal cartilage because of the anatomical and functional characteristics of the trachea. 1 The trachea is composed of C-shaped cartilage, respi-ratory epithelium, connective tissue including smooth muscle, and supporting blood supply.…”

Reconstruction of the trachea and carina: Surgical reconstruction, autologous tissue transplantation, allograft transplantation, and bioengineering

“…Unfortunately, no further results and prognosis have been reported. 26 In terms of the left lobe, a left thoracotomy has always been a challenge in carinal surgery, due to the fact that the existence of the aortic arch would not only deepen the surgical field but also restrict the exposure of the carina, trachea, and right main bronchus. It has been reported in the literature that left lobectomy is mainly performed through the left chest wall, but fewer carinal reconstructions are performed due to the difficulty of the procedure Figure 7.…”

Current concepts in tracheal reconstruction

“…Cadaveric tracheas were processed to remove native cells and major histocompatibility complex markers. Those patients who survived underwent on average 7.38 additional procedures (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. 1a).…”

“…Chen et al [12] reported two cases of using a pedicled bronchial flap to close a distal, lateral tracheal wall defect following bronchogenic carcinoma resection. In the first case, a right pneumonectomy was performed and the uninvolved inferior right main bronchus was rotated superiorly to close the lateral tracheal defect.…”