Fully-circumferential tracheal replacement: when and how?

Wurtz, Alain

doi:10.21037/med.2018.12.02

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…100,101 In summary, the restricted TE strategies for tracheal reconstruc- 121,122 The mismatch in mechanical properties, rigidity causing erosion of adjacent blood vessels, and the inability to integrate within surrounding tissue resulted in dislodgement during coughing and airway obstruction. 123 Other solid prostheses, including polyethylene (PE), 124 stainless-steel wire, 125 silicone stent, 126 and tantalum, 127 have also been explored as alternatives in tracheal reconstruction.…”

Section: Clinical Evaluation Of Te Scaffoldsmentioning

confidence: 99%

Tissue‐engineered tracheal implants: Advancements, challenges, and clinical considerations

Wei,

Zhang,

Luo

et al. 2024

Bioengineering & Transla Med

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Restoration of extensive tracheal damage remains a significant challenge in respiratory medicine, particularly in instances stemming from conditions like infection, congenital anomalies, or stenosis. The trachea, an essential element of the lower respiratory tract, constitutes a fibrocartilaginous tube spanning approximately 10–12 cm in length. It is characterized by 18 ± 2 tracheal cartilages distributed anterolaterally with the dynamic trachealis muscle located posteriorly. While tracheotomy is a common approach for patients with short‐length defects, situations requiring replacement arise when the extent of lesion exceeds 1/2 of the length in adults (or 1/3 in children). Tissue engineering (TE) holds promise in developing biocompatible airway grafts for addressing challenges in tracheal regeneration. Despite the potential, the extensive clinical application of tissue‐engineered tracheal substitutes encounters obstacles, including insufficient revascularization, inadequate re‐epithelialization, suboptimal mechanical properties, and insufficient durability. These limitations have led to limited success in implementing tissue‐engineered tracheal implants in clinical settings. This review provides a comprehensive exploration of historical attempts and lessons learned in the field of tracheal TE, contextualizing the clinical prerequisites and vital criteria for effective tracheal grafts. The manufacturing approaches employed in TE, along with the clinical application of both tissue‐engineered and non‐tissue‐engineered approaches for tracheal reconstruction, are discussed in detail. By offering a holistic view on TE substitutes and their implications for the clinical management of long‐segment tracheal lesions, this review aims to contribute to the understanding and advancement of strategies in this critical area of respiratory medicine.

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Section: Clinical Evaluation Of Te Scaffoldsmentioning

confidence: 99%

Tissue‐engineered tracheal implants: Advancements, challenges, and clinical considerations

Wei,

Zhang,

Luo

et al. 2024

Bioengineering & Transla Med

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Is extended resection for adenoid cystic carcinoma of the trachea questionable?

Wurtz

2022

European Journal of Cardio-Thoracic Surgery

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Extended autologous tracheal replacement by a novel pedicled thoraco-chondro-costal flap: a cadaveric proof of concept

de Frémicourt,

Wurtz,

Georgescu

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Our aim was to report an anatomic model of an autologous flap based on the internal thoracic blood supply: the pedicled thoraco-chondro-costal flap; and establish the feasibility of various types of extended tracheal replacement with this novel flap, according to a newly-proposed topographic classification. METHODS In cadaveric model, a cervicotomy combined with median sternotomy was performed. The incision was extended laterally to expose the chest wall. The internal thoracic pedicle was freed from its origin down to the upper limit of the delineated flap to be elevated. The perichondria and adjacent periostea were incised longitudinally to remove cartilages and adjacent rib segments, preserving perichondria and periostea. A full-thickness quadrangular chest wall flap pedicled on internal thoracic vessels was then elevated and shaped into a neo conduit to replace the trachea with the pleura as an inner lining. RESULTS Various types of extended non-circumferential and full-circumferential tracheal replacements were achieved with this composite flap. No anastomosis tension was noticed despite the absence of release manoeuvres. CONCLUSIONS This model could represent a suitable autologous tracheal substitute, which is long, longitudinally flexible, and eventually transversely rigid. No microsurgical vascular anastomoses are required. The technique is reproducible. The perichondria and periostea would regenerate vascularized neo-cartilaginous rings, potentially decreasing the need for long-term stenting. The inner pleural lining could potentially transform into ciliated epithelium as shown in previous preclinical studies.

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Fully-circumferential tracheal replacement: when and how?

Cited by 3 publications

References 21 publications

Tissue‐engineered tracheal implants: Advancements, challenges, and clinical considerations

Tissue‐engineered tracheal implants: Advancements, challenges, and clinical considerations

Is extended resection for adenoid cystic carcinoma of the trachea questionable?

Extended autologous tracheal replacement by a novel pedicled thoraco-chondro-costal flap: a cadaveric proof of concept

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