Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Tracheal Allotransplantation and Prefabrication For Long Tracheal Stenosis With Withdrawal of Immunosuppression - From Bed To Bench
Margot Den Hondt, MD, P. Delaere, J. J. Vranckx;
KULeuven INTRODUCTION: Few therapeutic options exist for repairing tracheal defects longer than 5 cm since no autologous fibrocartilagenous framework is available for reconstruction and trachea lacks an identifiable vascular pedicle that would enable direct anastomosis to recipient vessels.

MATERIALS AND METHODS: Based on our previous research, we reconstructed 6 long-segment tracheal defects using an allograft revascularized by heterotopic wrapping in radial forearm fascia. Patients received immunosuppressive therapy. After revascularization, the mucosal lining was replaced progressively using recipient buccal mucosa, creating a chimera of donor respiratory epithelium and recipient buccal mucosa. The chimera allowed for gradual withdrawal of immunosuppression. Four to ten months after implantation, the tracheal allograft was dissected with its new vascular pedicle and brought into its orthotopic location by microvascular techniques.

RESULTS: In all patients immunosuppressive therapy was withdrawn. In one patient vascularization problems of the mucosal lining occurred. Shortening the time span for the orthotopic transplantation limits quality of outcome. There is a fragile balance between the immunologic parameters and the vascularization of the internal lining.

CONCLUSION: Vascularization of the mucosal lining of the trachea determines the quality of outcome and timing of treatment. We currently analyze from bed to bench the impact of pro-angiogenic stem cell-based strategies in a rabbit model. We analyze the reduction of immunogenicity of the allogenic trachea by means of surgical and enzymatic decellularization techniques, and we investigate the replacement of inner lining by functional respiratory epithelium.


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