Reconstruction of the airway with a composite alloplastic and autogenous graft. An experimental study

A method by which an alloplast can be lined with mucosa and thereafter used as a composite pedicled graft is described and discussed. Autogenous buccal mucosa was transplanted to the pretracheal region in five beagles. Subsequently a cyst developed in which the graft constituted the main part of the cyst wall. After 5 to 6 weeks the cyst was explored and a Proplast sheet was sutured to its exterior. After another 3-9 weeks the area was explored again. A composite graft had then formed comprising buccal mucosa on the outside, stabilized by Proplast and supplied by blood vessels arising from the strap muscles and their fascia. After opening of the cyst, the composite graft was used to repair a tracheal defect in the same dog. All of the dogs survived and they did not lose any weight. The graft areas were removed 5 1/2-9 months after the tracheal window repair. Tracheoscopy was performed at least twice on each dog. The grafted areas were also studied by light microscopy, scanning electron microscopy and transmission electron microscopy. The grafts survived in all cases. There was no tendency towards graft extrusion. Connective tissue cells predominated in the pores of the Proplast framework, in which small foci of metaplastic bone formation were also seen.