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July 1995

New Technique for Laryngotracheal Mucosa Transplantation: 'Stamp' Welding Using Indocyanine Green Dye and Albumin Interaction With Diode Laser

Author Affiliations

From the Department of Otolaryngology—Head and Neck Surgery and the Eleanor Naylor Dana Laser Research Laboratory, Lahey Clinic, Burlington, Mass. Drs Wang, Rebeiz, and Shapshay are now with the Department of Otolaryngology—Head and Neck Surgery, New England Medical Center, Tufts University School of Medicine, Boston, Mass. Dr Gleich is now with the Department of Otolaryngology—Head and Neck Surgery, New York (NY) Eye and Ear Infirmary.

Arch Otolaryngol Head Neck Surg. 1995;121(7):773-777. doi:10.1001/archotol.1995.01890070059013

Objective:  To investigate (1) the possibility of survival of free mucosa "stamp" grafts fixed in the airway with a new technique using indocyanine green—dyed albumin solder activated with a diode laser and (2) the degree of improvement of wound healing in the airway by applying modified microskin transplantation techniques from burn surgery to cover a relatively large wound with a few small pieces of mucosa anchored in place with the previously mentioned technique.

Design:  Three (one control and two experimental) rectangular (10×8 mm) wounds in tracheal mucosa were produced in four experimental animals (dogs) using a carbon dioxide laser. The control wound was left uncovered. In the first experimental wound, a mucosal flap was raised and then fixed in place by a trapdoor flap method. In the second experimental wound, two small (each 2×3 mm) autogenous mucosa grafts were anchored onto the surface with indocyanine green—dyed albumin activated with an 810-nm diode laser. Histomorphologically, the postoperative results from three wounds were compared.

Results:  The experimental wounds were completely covered by regenerated squamous cells in 1 week and by ciliated epithelium in 2 weeks after the operation despite the discrepancy in size of the graft to wound area (1:6.7) covered with the stamp mucosa. No thermal damage from the diode laser was noted in the second experimental wounds. In the control wounds, no coverage was observed at 1 week, and only squamous cells were noted 2 weeks postoperatively. All the wounds had normal ciliated epithelium coverage at 4 weeks.

Conclusions:  Transplanted stamp grafts provided similar or better healing than trapdoor flap transplants. This new technique made endoscopic mucosal grafting possible and offers a potential breakthrough in the management of laryngotracheal stenosis.(Arch Otolaryngol Head Neck Surg. 1995;121:773-777)

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