[Experimental and clinical results of tracheal prosthesis]

Prosthetic reconstruction of the trachea was performed experimentally in mongrel dogs. Neville's prosthesis, which we used initially, has insufficient elasticity and flexibility. As a result, migration was observed after the reconstruction. To prevent such migration, we wrapped the prosthesis in Marlex mesh. Nevertheless, dehiscence and local infection occurred at the anastomotic site. We have developed a new Katsura prosthesis which is made of silicone rubber and has good elasticity and flexibility. However, the Katsura prosthesis was also unable to prevent dehiscence and local infection at the anastomotic site in the experiment. We have thus tested successive models of the Katsura prosthesis (model I-model V). Recently, we wrapped the prosthesis of model V in pedicled omentum instead of Marlex mesh to prevent the spread of infection to the mediastinum. In clinical cases who had a large surgical defect of the trachea and difficulty of primary anastomosis, we performed prosthetic reconstruction. We used Neville's prosthesis in 7 cases and the Katsura prosthesis in 5 cases. Severe complications were observed, such as arterial erosion and migration of the prosthesis. All the cases have died, although 5 cases survived for more than 1 year, and the longest survival time was 43 months. In the future, we hope that an ideal substitute for the trachea will be found and that prosthetic reconstruction will be able to safely performed, as in the case of vascular prosthesis.