Autologous tracheal replacement: from research to clinical practice

Area of Science:

• Regenerative Medicine
• Surgical Innovation
• Biomaterials in Surgery

Background:

• Synthetic materials and heterologous tissues have historically failed in durable tracheal replacement.
• Extended tracheal defects pose a significant surgical challenge.
• Autologous tracheal substitution (ATS) without synthetic materials or immunosuppression was explored.

Purpose of the Study:

• To investigate the efficacy of autologous tracheal substitution (ATS) for replacing extended tracheal defects.
• To present the experience with a novel ATS technique in a patient cohort.

Main Methods:

• A novel reconstruction technique using a forearm free fascio-cutaneous flap, vascularized by radial vessels and reinforced with rib cartilages, was developed.
• The flap was re-anastomosed to cervical vessels in a single-stage operation.
• Twelve patients with extended tracheal resections (mean 11 cm) underwent ATS for primary or secondary tracheal neoplasms and post-intubation tracheal destruction.

Main Results:

• The study presents the first animal model for tracheal resection and replacement with an autologous conduit.
• In 12 patients, ATS demonstrated successful extubation on postoperative day one, with 8 patients alive and without respiratory distress at a mean follow-up of 36 months.
• No airway collapse was detected; however, two patients died from pulmonary infection after resection extending to the carina, and two required tracheotomy due to anastomosis level.

Conclusions:

• Autologous tracheal substitution (ATS) serves as a viable and durable tracheal substitute, offering transverse rigidity without immunosuppression.
• Potential limitations include chronic respiratory insufficiency and cartilage calcification.
• Further research is needed to develop methods for lining the neo-trachea with ciliated respiratory epithelium.