Peritracheal membranous adipose tissue for early revascularization of the bronchial anastomosis

The effect of a peritracheal wrap of membranous adipose tissue on revascularization of the bronchial anastomosis after left lung autotransplantation was evaluated in four groups of dogs. The bronchial anastomosis was performed just distal to the carina in groups 1 (6 dogs) and 2 (7 dogs) and as close to the lobar division as possible in groups 3 (14 dogs) and 4 (7 dogs). Peritracheal membranous adipose tissue was used in groups 1 and 3 only. The other two groups served as controls. Three dogs from group 2 had elastic Dacron fabric wrapped around the anastomotic site. Revascularization of the distal bronchus through the wrap was demonstrated in all dogs in groups 1 and 3, 7 days after surgery by postmortem injection studies but not in control groups 2 and 4, and serious bronchostenosis was also observed in the latter two groups. Histologic examination of the bronchial anastomosis revealed better structural preservation of the bronchus distal to the suture line with the adipose tissue wrap. The dogs with elastic Dacron fabric wraps showed poor structural integrity below the suture line (necrosis and calcification). Our results suggest that the level of bronchial anastomosis does not alter the healing process of the distal bronchus when a peritracheal membranous adipose tissue wrap is applied to the anastomotic site. They also indicate that the wrap is effective in restoring vascular flow across the suture line within 1 week of lung autotransplantation.