Pediatric tracheal homograft reconstruction: A novel approach to complex tracheal stenoses in children Jeffrey P. Jacobs, MDa*, Martin J. Elliott, MD,

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Presentation transcript:

Pediatric tracheal homograft reconstruction: A novel approach to complex tracheal stenoses in children Jeffrey P. Jacobs, MDa*, Martin J. Elliott, MD, FRCSa, Marcus P. Haw, MD, FRCSa**, C.Martin Bailey, FRCSa, Claus Herberhold, MDb The Journal of Thoracic and Cardiovascular Surgery Volume 112, Issue 6, Pages 1549-1560 (December 1996) DOI: 10.1016/S0022-5223(96)70014-4 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 The actual homograft is shown as it appears on arrival from the homograft bank. Also shown are two Dumon stents. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 The anterior part of the trachea is removed leaving only the posterior tracheal wall and trachealis intact. The homograft is cut to size and sutured into place with interrupted horizontal mattress absorbable monofilament sutures. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 The stent is placed to support the homograft internally until reepithelialization has occurred, after which it is removed endoscopically usually 10 to 12 weeks after the operation. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Bronchoscopic examination 13 months after THR revealing a completely epithelialized homograft with a normal caliber airway from cricoid to carina. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Electron micrograph shows the appearance of the homograft in the first week after implantation. The absence of epithelium is apparent. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Eight weeks after THR, early epithelialization and budding can be seen on the surface of the underlying matrix. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 7 Two months after THR, the presence of ciliated respiratory epithelium is clearly demonstrated. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 8 Patient outcome.* Twenty-three of the 24 patients had had unsuccessful prior tracheal reconstruction. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 9 Actuarial survival (Kaplan-Meier) after tracheal homograft replacement in children. GI, Gastrointestinal. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 1549-1560DOI: (10.1016/S0022-5223(96)70014-4) Copyright © 1996 Mosby, Inc. Terms and Conditions