Experimental reconstruction of the intrathoracic trachea using a new prosthesis made from collagen grafted mesh

Abstract

Intrathoracic tracheal replacement was performed in dogs using a tracheal prosthesis we had constructed from mesh. The prosthesis consists of Marlex mesh (polypropylene) reinforced with a continuous polypropylene spiral, and is grafted and coated with pig collagen (Types I and III). Complete surgical resection of the mediastinal trachea was performed in seven adult mongrel dogs. In 1 dog, a 4 tracheal ring segment (2 cm) was resected and replaced with a 3 cm prosthesis, and in 6 dogs, a 7 to 8 tracheal ring segment (4 cm) was resected and replaced with a 5 cm prosthesis. In the latter six dogs, a silicone tube was temporarily inserted into the replacement, and removed by bronchoscopy one month after surgery. In one dog that received a 4 cm replacement, we added omentopexy around the reconstructed trachea. The prostheses in all dogs were promptly infiltrated by surrounding tissue and incorporated by the host trachea. No dehiscence or air leakage was observed after surgery. Mild luminal stenosis was evident in one dog, and partial exposure of the mesh (ulceration) was observed in five dogs within an observation period of 3 to 26 months. However, in the dog that received omentopexy after tracheal reconstruction, no stenosis or ulceration was observed, and the luminal surface seemed lustrous even after 6 weeks. Formation of respiratory epithelium, which lined the prosthetic lumen, was seen to various degrees: in the 2 dogs killed 12 months and 26 months after surgery, confluent epithelization was confirmed histologically from the upper to the lower anastomosis of the prosthesis. The tracheal prosthesis is useful for the repair of intrathoracic tracheal defects and shows promise for clinical application with further investigation.