Current Solutions for Long-Segment Tracheal Reconstruction

Abstract

This article is a continuation of previous reviews about the appropriate method for long-segment tracheal reconstruction. We attempted to cover the most recent, successful and promising results of the different solutions for reconstruction that are rather innovative and suitable for imminent clinical application. Latest efforts to minimize the limitations associated with each method have been covered as well. In summary, autologous and allogenic tissue reconstruction of the trachea have been successful methods for reconstruction experimentally and clinically. Autologous tissues were best utilized clinically to enhance revascularization, whether as a definitive airway or as an adjunct to allografts or tissue-engineered trachea (TET). Allogenic tissue transplantation is, currently, the most suitable for clinical application, especially after elimination of the need for immunosuppressive therapy with unlimited supply of tissues. Similar results have been reported in many studies that used TET. However, clinical application of this method was limited to use as a salvage treatment in a few studies with promising results. These results still need to be solidified by further clinical and longterm follow-up reports. Combining different methods of reconstruction was often required to establish a physiological rather than an anatomical trachea and have shown superior outcomes.

Selection of the optimum 3D‐printed pore and the surface modification techniques for tissue engineering tracheal scaffold in vivo reconstruction

“…These processes will increase the risk of infection and more expenditure, and for instance, it could not meet the needs of patients with airway defects in an emergency situation. While the synthetic materials have the particular advantages of modification and customization according to the specific needs of patient, a short preparation cycle, storage convenience, and so forth, it also needs to recognize that there are still some issues associated with the application of synthetic scaffolds, such as the lack of revascularization and insufficient integration with the native tissue, which will result in graft material hardening and migration; 3D printing technology was born in the 1990s and initially used in manufacturing, aerospace model design, and other fields. Now it has developed and became widely used in medicine .…”

“…The tensile test results of this experiment show that the longitudinal mechanical properties of the PTS are obviously superior to the native scaffold. As reported in many articles, the synthetic material has a natural advantage in simulating the mechanical properties of the tissue . The tracheal material requires not only the strength of the long axis but also a certain degree of radial toughness, so three‐point bending and radial compression tests were performed.…”

“…As reported in many articles, the synthetic material has a natural advantage in simulating the mechanical properties of the tissue. 1,3,7 The tracheal material requires not only the strength of the long axis but also a certain degree of radial toughness, so threepoint bending and radial compression tests were performed. The PTS also showed stronger mechanical properties than the native scaffold.…”

“…The maximum resectable length of the trachea is restricted to 30% of the total length in children or 50% in adults . Tracheal replacement therapy is undertaken to relieve the anastomotic tension . An ideal engineered tracheal matrix should support cell adhesion, proliferation, and have a similar mechanical force to the native tissue, which supports the structure of an open airway .…”

“…2 Tracheal replacement therapy is undertaken to relieve the anastomotic tension. 3 An ideal engineered tracheal matrix should support cell adhesion, proliferation, and have a similar mechanical force to the native tissue, which supports the structure of an open airway. 4 At present, the methods based on the decellularized and the biosynthetic scaffolds are widely used.…”