Staged replacement of the canine trachea with ringed polyethylene terephthalate grafts

The reconstruction of extensive defects of the trachea ist best accomplished by the use of the patient's own tissue. Unfortunately, this is not always feasible and several prosthetic devices for replacement of the trachea have been described. In an experimental study staged tracheal replacements were performed in five dogs using a ringed polyethylene terephthalate (PET) tubular prosthesis previously cultured in the major omentum of the subjects. A set of stainless-steel arches embodied in silicone compound was designed to prevent collapse of the prosthesis. One of the subjects died on the 10th post-operative day of an unidentified cause and the remaining four eventually developed signs of respiratory distress. The cause of the respiratory insufficiency was anastomotic stenosis in every case. Infection, erosion, collapse or displacement were not observed. The rings designed to avoid collapse of the prosthesis represent a suitable alternative for use as external reinforcement in the tracheal situation. The PET grafts implanted as tracheal prosthesis according to the guidelines of this protocol consistently developed anastomotic stenosis and failed to support a functional respiratory epithelium. A further conclusion is that the use of absorbable sutures encourages anastomotic dehiscence and thus must be avoided.