Organic and Synthetic Substitutes in Tracheal Reconstruction: A Scoping Review (2015-2025)

Tracheal defects have been the focus of research since the 19th century, but reconstructing this complex structure remains challenging. Identifying a safe, effective tracheal substitute is a key goal of surgery. This integrative review explores current tracheal substitutes and tissue engineering techniques. Data were collected from June 2024 to March 2025 from electronically available databases. Articles published between 2015 and 2025 were selected using the individualized protocol for each database. After screening 190 articles, 82 were excluded, and 108 were reviewed, with 100 meeting the final inclusion criteria. Recent substitutes include three-dimensional synthetic grafts made from polycaprolactone and copolyamide with thermoplastic elastomer, thermoplastic polyurethane and polylactic acid. Additionally, models using decellularized and recellularized tracheal matrix scaffolds and bioprinting techniques are being developed. Comparative studies of synthetic grafts and tracheal scaffolds, as well as cell self-aggregation methods to create tracheal analogues, are discussed. Advances in hybrid approaches combining synthetic polymers with extracellular matrix components aim to improve biocompatibility and functional integration. The importance of selecting appropriate preclinical animal models, such as goats, is also highlighted for translational relevance. Further research is required to refine protocols, overcome challenges related to vascularization and immune response, and ensure the development of clinically viable, long-lasting tracheal substitutes.