Advances in tracheal reconstruction and tissue engineering

Abstract

Tracheal stenosis represents a significant challenge. Surgeons continue to search for appropriate reconstructive techniques and grafting materials for long tracheal segment reconstruction. Grafts can be classified as synthetic, allogenic, autogenic, transplant, and engineered. Although none of these grafts have provided overwhelming success, acellular composite engineered grafts have shown early promise and can be applied in benign and malignant tracheal diseases. Intraluminal granulation tissue causing re-stenosis is the biggest challenge in tracheal reconstruction. Tracheal wound healing and tissue regeneration pathways must be deeply explored and better characterized to advance the field of tracheal reconstruction.

Identifying Molecular Pathophysiology and Potential Therapeutic Options in Iatrogenic Tracheal Stenosis

“…Finally, the tracheal stenosis-mitigating effects of retinoic acid can be extended to more experimental applications, such as tracheal graft bioengineering. While these investigational grafts were shown to remain patent and effective beyond the immediate postoperative period, their permanent success was precluded by the development of tracheal granulation tissue causing stenosis and luminal occlusion [ 29 , 30 , 31 , 32 , 33 , 34 ]. Molecular analysis of the tracheal granulation tissue from the stenotic grafts in the porcine pre-clinical models revealed dysregulations in cellular pathways including inflammation and extracellular matrix remodeling [ 35 ].…”