Prefabricated microvascular autograft in tracheal reconstruction

Area of Science:

• Biomaterials Science
• Regenerative Medicine
• Surgical Innovation

Background:

• Tracheal reconstruction remains a significant challenge in head and neck surgery.
• Existing methods using alloplasts or composite grafts often fail due to complications like infection and restenosis.
• Recent advancements in soft-tissue molding and bone induction offer new possibilities.

Purpose of the Study:

• To develop a rodent model for fabricating a well-vascularized tracheal autograft.
• To investigate the potential of combining soft-tissue molding, bone induction, and microvascular free tissue transfer for tracheal reconstruction.
• To create a flexible neotrachia with adequate structural support.

Main Methods:

• A cylindrical silicone mold was wrapped with vascularized adductor thigh muscle, pedicled on femoral vessels.
• Tracheal rings were formed using bone morphogenetic protein-primed demineralized bone matrix in muscle troughs.
• The composite graft was designed to mimic native tracheal dimensions and flexibility.

Main Results:

• Harvested grafts at 2 weeks showed rigid skeletal support from heterotopic bone formation in rings.
• A smooth inner lining was achieved through fibroplasia, creating a functional neotrachia.
• Bone formation was confined to the troughs, preserving intervening soft tissue for flexibility.

Conclusions:

• A homologous, vascularized tracheal autograft was successfully fabricated using a novel rodent model.
• This prefabrication technique, utilizing soft-tissue molding and bone induction, holds significant potential for head and neck reconstruction.
• The method offers a promising solution for creating functional and flexible tracheal replacements.