Current Solutions for Long-Segment Tracheal Reconstruction

Abstract

This article is a continuation of previous reviews about the appropriate method for long-segment tracheal reconstruction. We attempted to cover the most recent, successful and promising results of the different solutions for reconstruction that are rather innovative and suitable for imminent clinical application. Latest efforts to minimize the limitations associated with each method have been covered as well. In summary, autologous and allogenic tissue reconstruction of the trachea have been successful methods for reconstruction experimentally and clinically. Autologous tissues were best utilized clinically to enhance revascularization, whether as a definitive airway or as an adjunct to allografts or tissue-engineered trachea (TET). Allogenic tissue transplantation is, currently, the most suitable for clinical application, especially after elimination of the need for immunosuppressive therapy with unlimited supply of tissues. Similar results have been reported in many studies that used TET. However, clinical application of this method was limited to use as a salvage treatment in a few studies with promising results. These results still need to be solidified by further clinical and long-term follow-up reports. Combining different methods of reconstruction was often required to establish a physiological rather than an anatomical trachea and have shown superior outcomes.

Keywords: airway reconstruction; airway transplantation; tissue-engineered trachea; tracheal replacement; tracheal substitutes; tracheal transplantation.

Fig. 1. Comparison between the cost of TET reported by Hamilton et al.⁴³⁾ and the costs of common organ transplantation as reported in the Milliman, Inc. 2014 report.⁴⁶⁾ TET: tissue-engineered trachea

Fig. 2. The staged process of regenerating a tracheal substitute suitable for tracheal reconstruction.