Successful tracheal replacement in humans using autologous tissues: an 8-year experience

Ann Thorac Surg. 2013 Oct;96(4):1146-1155. doi: 10.1016/j.athoracsur.2013.05.073. Epub 2013 Aug 30.


Background: Fifty years of surgical research using synthetic materials and heterologous tissues failed to find a good, durable replacement for the trachea. We investigated autologous tracheal substitution (ATS) without synthetic material or immunosuppression.

Methods: For ATS, we used a single-stage operation to construct a tube from a forearm free fasciocutaneous flap vascularized by radial vessels that was reanastomosed to internal mammary vessels and reinforced by rib cartilages interposed transversally in the subcutaneous tissue. Tracheal resections 7 to 12 cm long (mean, 11 cm) were done to treat 8 primary tracheal neoplasms, including 5 adenoid cystic carcinomas (ACC) and 3 squamous cell carcinomas (SCC); 3 secondary tracheal neoplasms, including 1 thyroid carcinomas and 2 lymphomas; and 1 postintubation tracheal destruction after a long history of stenting. Transitory tracheotomy was associated to the absence of mucociliary clearance.

Results: ATS has been performed in 12 patients since 2004, with additional resections in 4 patients, comprising 1 carinal resection alone, 1 associated with lobectomy, and 2 pharyngolaryngectomies. All patients were extubated on postoperative day 1. Eight patients are alive at a mean of 36 months (range, 2 to 94 months) postoperatively, with no respiratory distress. The 2 patients with ATS and carinal resections died of pulmonary infection. No airway collapse has been detected by endoscopy, dynamic computed tomography scan, or spirometry. Two patients still have a tracheotomy because the procedure was performed too low at the level of the proximal anastomosis. One patient with a chronic severe respiratory insufficiency recently required a distal, short stent.

Conclusions: ATS is a good, durable, tracheal substitution that resists respiratory pressure variations because of transverse rigidity, without any immunosuppression.

Keywords: 15.

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Otorhinolaryngologic Surgical Procedures / methods
  • Retrospective Studies
  • Surgical Flaps*
  • Trachea / surgery*
  • Tracheal Neoplasms / surgery*
  • Transplantation, Autologous