Advances in tracheal reconstruction

Abstract

A recent revival of global interest for reconstruction of long-segment tracheal defects, which represents one of the most interesting and complex problems in head and neck and thoracic reconstructive surgery, has been witnessed. The trachea functions as a conduit for air, and its subunits including the epithelial layer, hyaline cartilage, and segmental blood supply make it particularly challenging to reconstruct. A myriad of attempts at replacing the trachea have been described. These along with the anatomy, indications, and approaches including microsurgical tracheal reconstruction will be reviewed. Novel techniques such as tissue-engineering approaches will also be discussed. Multiple attempts at replacing the trachea with synthetic scaffolds have been met with failure. The main lesson learned from such failures is that the trachea must not be treated as a "simple tube." Understanding the anatomy, developmental biology, physiology, and diseases affecting the trachea are required for solving this problem.

Fig. 1.

Cellular composition of the human tracheal epithelium.

Fig. 2.

Human trachea harvested intraoperatively from donor lung used for transplantation.

Fig. 3.

Decellularized scaffold and bioreactor setup in incubator. Adapted from Haykal S, Salna M, Zhou Y, et al. Double-chamber rotating bioreactor for dynamic perfusion cell seeding of large segment tracheal allografts: comparison to conventional static methods. Tissue Eng Part C Methods 2014 Mar 5. [Epub ahead of print]. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.