Experimental And Clinical Replacement Of Artificial Tracheal Prosthesis By Two-stage Procedure With Memory-alloy Mesh

Objective: It is up to now still a great challenge to surgeons all over the world to reconstruct long-segment defect of the trachea. One of the best ways to resolve this dilemma is artificial tracheal prosthesis. However, all the efforts are in vain. Bad compatibility with recipients' tissues and especially not covering with endothelium made all artificial prosthesis only a "stent". The authors try to design an artificial trachea that can totally heal with native trachea. Methods: Hybrid 20 dogs are randomized into a pedicle group and a nonpedicle group. Each group is 10. Tracheal resection and reconstruction were completed with two-stage operative procedure. Memory alloy mesh was buried beneath the right cervical skin of the dog in the first stage. The "sandwich" artificial tracheal prosthesis with memory-alloy mesh as the skeleton was made by plastic surgery in the second stage after three weeks. Six-ring cervical trachea was resected and replaced with this artificial trachea made. Survival period and complications were recorded. Later, three patients with tracheal tumor underwent radically resected procedure and the trachea was primarily reconstructed clinically. Results: Seven dogs in pedicle group survived well except three dead, one from anastomosed stricture and two from infection. The longest survivial period was over two years. All dogs in nonpedicle goup were dead within four weeks because of stenosis or infection. The postoperative recovery has so far been free of complications. Postoperative survivial periods were 12 months, four months and three months respectively. Two patients' lifestyle and activities are normal, even for the rigors of rural farm labor except for one patient with hemiparalysis. Conclusions: "Sandwich" artificial trachea made from memory alloy mesh by two-stage operative procedure is up to now the artificial trachea closest to human native trachea, which can completely heal with native trachea and become a real part of it. It is a great breakthrough of tracheal reconstruction and artificial tracheal prosthesis in the field of tracheal surgery.