Tracheal reconstruction with a synthetic material in a porcine model

The technique of tracheal reconstruction with costal cartilage or a pericardial patch has resulted in successful management of many patients with tracheal stenosis. Yet, it is often difficult, if not impossible, to harvest enough cartilage in a neonate. Pericardial patches are flimsy and can collapse. This pilot study evaluated the use of absorbable plates made of an alloplastic material, Lactosorb, as a substitute for cartilage on a growing porcine trachea. The rectangular plates were fashioned into an inverted U and placed into the airway through an anterior tracheal split. This placement resulted in granulation formation and failure. The plates were then fashioned into an I configuration and placed inside and outside the tracheal lumen. This attempt also resulted in failure, secondary to respiratory distress. Finally, the plates were fashioned into an inverted U and placed outside the trachea. In 67% of the subjects, the distraction was maintained and growth continued for the duration of the study. The stent was completely absorbed, with minimal scar or granulation tissue, in 4 months. In 1 subject, the stent migrated, and 1 subject died of a mucous plug. This study suggests that Lactosorb has no role in intraluminal stenting, but that it may be a viable alternative to a pericardial patch or cartilage in tracheal reconstruction when it is placed outside the airway lumen in a young animal.