[Experimental reconstruction of the mediastinal trachea with autogenous material-hydroxyapatite-omentum complex]

Reconstruction of extensive tracheal defects remains a difficult surgical problem. An experiment with one stage reconstruction of the thoracic trachea was performed in 32 adult mongrel dogs using a complex consisted of 3 layers as follows; autogenous materials as the inner layer, Hydroxyapatite (HA) ring as the middle layer, pedicled omental flap as the outer layer. Mediastinal tracheal defects (3-5 rings) were created and primarily reconstructed with the autogenous materials (Group 1: Pericardium, Group 2: Full thickness skin), supported with horseshoe-shaped HA rings, then covered with the pedicled omental flap. In the tracheal lumen a temporary silicone tube stent was inserted, and following groups were provided according to the duration of insertion of the stent: Group 1a:1 week, Group 1b:6 weeks, Group 1c:6 months in the cases of pericardium, Group 2a:1 week and Group 2b:6 weeks in the cases of skin graft. Three were the cases of early death. In Group 1a (n = 4) and Group Ib (n = 8), severe or moderate stenosis was noted in most cases. In Group 1c (n = 7), no stenosis occurred and ciliated epithelium was seen in 2 dogs, however, stenosis occurred moderately in 3 dogs and severe in 2. In group 2a (n = 8), moderate stenosis was seen in 1 dog due to the displacement of HA ring. No stenosis occurred in 7 other dogs. In Group 2b (n = 2), HA rings had been naked due to necrosis or infection of the skin graft in both cases.(ABSTRACT TRUNCATED AT 250 WORDS)