Open Access
CC BY 4.0 · Surg J (N Y) 2024; 10(04): e43-e52
DOI: 10.1055/s-0044-1792126
Original Article

Tracheal Replacement: A Scoping Review

Darin T. Johnston
1   Uniformed Services University, Craniomaxillofacial Trauma & Reconstruction, Oral & Maxillofacial Surgery, David Grant Medical Center, Travis AFB, California
2   Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
,
2   Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
,
Matthew G. Hartwig
3   Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
,
Russel R. Kahmke
4   Department of Head and Neck Surgery and Communication Sciences, Duke University Hospital, Durham, North Carolina
,
Linda C. Cendales
2   Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
› Institutsangaben
Preview

Abstract

Objective To summarize patient characteristics and outcomes for the historical and current methods of long-segment tracheal replacement in humans.

Materials and Methods A single reviewer screened the abstracts and full texts using Covidence for file management. Studies published in English that reported human subjects with circumferential or near-circumferential (>270 degrees) cervical tracheal replacements were included. Articles with subjects treated with primary anastomosis alone, retracted articles, abstracts, expert opinion articles, and conference presentations were excluded.

Results A total of 32 articles were included in the review reporting 156 cases of long-segment tracheal replacement including synthetic (alive at 1–8 years n = 6/64), regenerative medicine (dead at 15 days–55 months n = 4, not reported n = 6), cadaveric tracheal allograft (alive at 5 months–10 years n = 32/38), aortic allograft (alive at 6–85 months n = 12/16), free tissue transfer (alive at 6–108 months n = 13/21), allotransplantation (alive at 6–24 months n = 5/8), and vascular composite allograft (VCA) (alive at 20 months n = 1/1).

Conclusion Silicone and Marlex prostheses have poor long-term outcomes. The cadaveric tracheal allograft can only replace near-circumferential tracheal defects and is therefore limited to benign tracheal pathology. Inadequate structural support plagues the aortic allograft and often requires numerous invasive procedures and maintenance of an intraluminal stent. A lack of mucociliary clearance exists in all methods of tracheal replacement except cadaveric tracheal allograft and VCA and can cause fatal mucous plugging and chronic pulmonary infections. VCA and allotransplantation require long-term immunomodulation therapy.



Publikationsverlauf

Eingereicht: 06. August 2024

Angenommen: 07. Oktober 2024

Artikel online veröffentlicht:
12. November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA