Original Articles
Porous-Type Tracheal Prosthesis Sealed With Collagen Sponge

https://doi.org/10.1016/S0003-4975(97)00755-8Get rights and content

Abstract

Background. Reconstruction of a long section of the trachea is clinically problematic. Tracheal reconstructions using prostheses have met with limited success due to local infection, hemorrhage, luminal stenosis and prosthesis dislocation.

Methods. We have designed a porous type of tracheal prosthesis in which the mesh is sealed with collagen sponge. We used this prosthesis (50 mm in length) to reconstruct the cervical trachea in 10 mongrel dogs and evaluated its efficacy.

Results. One dog died due to an accident with anesthesia at 6 weeks and 1 of suffocation at 10 weeks. The other 8 dogs had an uneventful postoperative course until they were killed between 6 and 24 months after implantation. At sacrifice, all the prostheses had become completely incorporated into the host. Microscopic examination revealed advanced formation of a new epithelial lining in 1 dog at 6 months, and a confluent epithelial lining was observed in another dog at 12 months. Central stenosis was not significant in any of the animals.

Conclusions. This tracheal prosthesis gives good results in canine tracheal reconstruction, and appears very promising for the clinical repair of tracheal defects.

Section snippets

Collagen Solution

Collagen was extracted from pig skin and treated with a method similar to that described in our previous study [5]. It was supplied by Nippon Meat Packers Inc, Ibaraki, Japan. This purified collagen, which consisted of type I collagen (70% to 80%) and type III collagen, was dissolved in hydrochloric acid solution with a pH of 3.0, so that its concentration became 1.3%.

Prosthesis

The bulk structure of the prosthesis was the same as we used in the previous study 5, 6. It consisted of a fine Marlex mesh (CR

Results

Neither operative death nor dehiscence of the tracheal prosthesis occurred in any animal. Two dogs died within 3 months of tracheal reconstruction. One died of an anesthetic accident during bronchoscopic examination at 6 weeks, and the other of suffocation by sputum at 10 weeks. Eight dogs were killed between 6 and 24 months; 3 dogs at 6 months, 4 at 12 months, and 1 at 24 months (Table 1).

Comment

Reconstruction of circumferential tracheal defects is performed after tissue extirpation in cancer or resection of stenotic regions, and an end-to-end anastomosis is now considered to be the method of choice for defects of up to approximately 6 cm in adults 7, 8, 9. However, in the case of larger defects, another method of reconstruction is required. Researchers encouraged by the success of artificial vascular grafts have developed a variety of tracheal prostheses using synthetic biomaterials.

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