Laryngotracheal Reconstruction With Cryopreserved Aortic Allograft as a Salvage Technique When Cricotracheal Resection Complications Occur in Paediatrics

Current Solutions for Long-Segment Tracheal Reconstruction

“…The authors suggested that the trachea may be used as a composite tissue allotransplant with heterotopic revascularization in the forearm; however, maximizing cell repopulation in the recipient may be important in maintaining the viability of the transplant after stopping immunosuppression. 28) In 2014, Zanetta et al, 29) attempted to reconstruct the larynx and trachea with a 10-cm CAA as a last resort after complicated cricotracheal resection in a 4-year-old girl with tracheostomy and laryngeotracheal stenosis after prolonged intubation. The graft was further augmented with a thymopericardial-flap and a nasotracheal tube was left in place.…”

Fully-circumferential tracheal replacement: when and how?

“…In the latter two situations, the use of a tracheal substitute for fully-circumferential tracheal replacement (FTR) is mandatory. Occasionally, the tracheal substitute may be useful to treat a large congenital/acquired benign stenosis or malacia, or a dehiscence after tracheal or cricotracheal resection reconstruction by primary anastomosis ( 2 ).…”

“…In practice, both aortic allografts (n=10) and composite grafts based on the forearm free flap (n=14) have been widely used for FTR, with quite similar results in the postoperative period [in-hospital mortality rate of 20% (2/10 patients) vs. 21% (3/14 patients)]. The aortic allograft has several advantages: it is readily available in tissue banks, microbiologically safe, and its availability is particularly useful in an emergency setting ( 2 ). From a practical point of view, a complete graft wrap with bulky and well-vascularized flaps is required to promote neoangiogenesis and avoid microfistulization ( 13 , 14 ).…”