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October 1994

Tracheal Autograft Revascularization and Transplantation

Author Affiliations

From the Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Leuven, Belgium.

Arch Otolaryngol Head Neck Surg. 1994;120(10):1130-1136. doi:10.1001/archotol.1994.01880340070012

Objective:  No vascular pedicle can be obtained reasonably to provide revascularization of a tracheal graft by direct microvascular suture. This study is a morphometric analysis of epithelial regeneration, submucosal revascularization, and mucosal thickness of isolated, tracheal segments revascularized by a lateral thoracic fascial flap. The purpose of the first part of the study is to determine the optimal period of tracheal viability after isolation and revascularization. The second part consisted of a reimplantation of the revascularized autograft into its original tracheal location.

Design:  A tracheal segment was excised in 30 animals, and the segment was wrapped in the lateral thoracic fascia. The segments were reviewed histologically and morphometrically 2 to 28 days after graft isolation and after injection of the lateral thoracic artery with a blue silicone dye. Twelve grafts were reimplanted. Six segments were reinserted in the original direction and six segments were reinserted in the opposite direction. Tracheal airway clearance was studied by observation of the movement of carbon particles placed at different locations on the native and transplanted tracheal mucosa.

Mean Outcome Measures:  Tracheal autograft revascularization and reepithelialization.

Results:  Histologic evaluation of the revascularized grafts revealed an optimal viability of the autograft 16 to 20 days after isolation. The autografts could be reimplanted successfully after this period. This demonstrated the viability of the isolated grafts after a revascularization period of 16 days. The original direction of the mucosal clearance was preserved after reimplantation. The clearance in the opposite direction, with the 180° rotated segments, however, had no influence on survival.(Arch Otolaryngol Head Neck Surg. 1994;120:1130-1136)

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