Tracheal Replacement: A Scoping Review

Area of Science:

• Thoracic surgery
• Regenerative medicine
• Biomaterials

Background:

• Tracheal replacement is crucial for extensive airway defects.
• Historical and current techniques vary significantly in patient outcomes.
• Understanding these differences is vital for clinical decision-making.

Purpose of the Study:

• To summarize patient characteristics and outcomes of long-segment tracheal replacement.
• To compare historical and current methods for tracheal reconstruction.
• To identify limitations and benefits of different tracheal replacement strategies.

Main Methods:

• Systematic review of English-language studies.
• Inclusion criteria: human subjects with >270-degree cervical tracheal replacements.
• Exclusion criteria: primary anastomosis alone, retracted articles, non-human studies.

Main Results:

• 32 articles reported 156 cases of long-segment tracheal replacement.
• Synthetic prostheses (e.g., Silicone, Marlex) showed poor long-term survival.
• Cadaveric tracheal allografts, aortic allografts, free tissue transfer, allotransplantation, and vascular composite allografts (VCAs) demonstrated variable survival rates with specific limitations.

Conclusions:

• Synthetic tracheal prostheses have inadequate long-term outcomes.
• Cadaveric tracheal allografts are limited to benign pathologies due to near-circumferential defect replacement.
• Allografts and VCAs lack mucociliary clearance, risking mucous plugging and infection; VCA and allotransplantation necessitate long-term immunosuppression.