Mechanical Characterization of Slide Tracheoplasty Versus End-to-End Anastomosis in Ex Vivo Porcine Tracheas

Slide tracheoplasty and end-to-end anastomosis are two common reconstructive techniques for airway stenosis. While slide tracheoplasty is often preferred for its larger luminal diameter and reduced anastomotic tension, its mechanical integrity relative to end-to-end repair remains incompletely characterized. This study aimed to compare tensile strength and elastic properties between the two repair techniques in an ex vivo porcine model.

Porcine tracheas were harvested, bisected, and reattached using either end-to-end anastomosis or slide tracheoplasty. Tensile testing was performed to a maximum load of 45 N using a uniaxial testing system. Load at failure, stress-strain behavior, and Young's modulus were calculated. Survival analysis was performed using the log-rank test to compare construct integrity between groups. Negative and positive pressure testing was performed.

Seventy-five percent of slide tracheoplasty samples failed under tension, with a median failure load of 32.96 N, whereas none (0%) of the end-to-end repairs failed within the 45 N test limit (p = 0.0401). At equivalent strain, slide tracheoplasty constructs demonstrated lower stress compared with end-to-end anastomoses. Young's modulus was similarly reduced in the slide group.

Slide tracheoplasty constructs demonstrated lower tensile strength and stiffness than end-to-end repairs, suggesting that the redistribution of mechanical forces across a larger surface area reduces localized stress but limits overall load-bearing capacity. This broader force dispersion may protect the anastomotic site from focal tension and dehiscence but results in susceptibility to elongation or deformation under chronic strain. These mechanical considerations are important for surgeons when selecting a repair technique and ensuring long-term postoperative airway stability.

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