Objective: To explore the clinical application of supraclavicular fasciocutaneous island flap (SIF) in the repair of tracheal defect. Methods: From May 2016 to March 2021, the clinical data of 10 patients (8 males,2 females,aged 27-73 years old) were retrospectively analyzed who underwent repair surgery with SIF for trachea defects after resection of cervical or thoracic tumors, including 2 cases of laryngotracheal adenoid cystic carcinoma, 2 cases of laryngeal carcinoma, 3 cases of esophageal carcinoma, 2 cases of thyroid carcinoma and one case of parathyroid carcinoma. All of the primary tumors were at T4. The outcomes of 10 cases with tracheal defect repaired by SIF were evaluated. Results: The areas of the SIF were (3-7) cm × (6-10) cm, the thicknesses of the flaps were 8-11 mm, and the lengths of the pedicles were 10-15 cm. The blood supply of the SIF came from the transverse carotid artery. The skin defects of the donor areas of the shoulders were directly closed. After 1-60 months of follow-up, all the flaps survived. The flaps, tracheas as well as shoulder wounds healed well. Conclusion: The SIF is suitable for the repair of tracheal defects. It has perfect thickness compatible with the trachea. The technique is simple and microsurgical technique is not needed, with a good application prospect.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin Transplantation ; Surgical Flaps ; Trachea ; Treatment Outcome

BACKGROUNDRe-epithelialization has remained a major obstacle in both tracheal and lung transplantations. This study examines the realization of re-epithelialization by epithelial inoculation in a rat heterotopic tracheal transplantation model.

METHODSThe original epithelia of tracheas from donor Wistar rats were removed and the tracheas were then inoculated with 10(6)/ml in vitro cultured epithelial cells of the Spraque-Dawley (SD) rat phenotype. These allo-tracheas were then heterotopically transplanted into SD rats. After 28 days, the allo-trachea tissues were recovered and assessed for epithelial morphology and cellular differentiation using immunohistochemical analysis. An additional experimental group was used to compare the outcomes of re-epithelialization in immunosuppressed animals.

RESULTSHistological examination showed that allografts with epithelial inoculation maintained patent tracheal lumens, which were obliterated in controls. Recipient immunosuppression facilitated the formation of an integrated ciliated epithelial layer, further demonstrated by the presence of a dense cilia population, a well-developed plasma membrane, and readily recognizable intercellular junctions. Epithelial cellular differentiation markers such as cytokeratin 14 and 18, and cystic fibrosis transmembrane conductance regulator (CFTR) were all positive in allografts under immunosuppression.

CONCLUSIONConcurrent recipient-derived epithelial inoculation with immunosuppression can result in complete re-epithelialization with the recipient phenotype and suppress the luminal obliteration process in heterotopic transplantations.

Allografts ; cytology ; Animals ; Bronchiolitis Obliterans ; surgery ; Epithelial Cells ; cytology ; Female ; Male ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar ; Trachea ; cytology ; transplantation ; Transplantation, Heterotopic

Aspergillus tracheobronchitis is a form of invasive pulmonary aspergillosis in which the Aspergillus infection is limited predominantly to the tracheobronchial tree. It occurs primarily in severely immunocompromised patients such as lung transplant recipients. Here, we report a case of Aspergillus tracheobronchitis in a 42-year-old man with diabetes mellitus, who presented with intractable cough, lack of expectoration of sputum, and chest discomfort. The patient did not respond to conventional treatment with antibiotics and antitussive agents, and he underwent bronchoscopy that showed multiple, discrete, gelatinous whitish plaques mainly involving the trachea and the left bronchus. On the basis of the bronchoscopic and microbiologic findings, we made the diagnosis of Aspergillus tracheobronchitis and initiated antifungal therapy. He showed gradual improvement in his symptoms and continued taking oral itraconazole for 6 months. Physicians should consider Aspergillus tracheobronchitis as a probable diagnosis in immunocompromised patients presenting with atypical respiratory symptoms and should try to establish a prompt diagnosis.
Adult ; Anti-Bacterial Agents ; Antitussive Agents ; Aspergillosis, Allergic Bronchopulmonary ; Aspergillus* ; Bronchi ; Bronchoscopy ; Cough ; Diabetes Mellitus ; Diagnosis ; Gelatin ; Humans ; Immunocompromised Host* ; Invasive Pulmonary Aspergillosis ; Itraconazole ; Lung ; Sputum ; Thorax ; Trachea ; Transplantation

OBJECTIVE: To explore the histopathological changes of the new trachea reconstruction with a scraped partial mucosa jejunal autograft hy microscope and transmission electron microscope. METHOD: Eight canine models of extensive circumferential tracheal defects with revascularized jejuna combined with NiTi alloy mesh tube were established. Operations were performed on these dogs under general anesthesia by intravenous ketamine. A 6.5 cm length of segment of the jejunum was resected. The graft was prepared by scraping the partial mucosa with operating knife blade and dry gauze. During the resecting course, micro-vascular anastomoses were done between the mesenteric artery and the right common carotid artery,and the mesenteric vein with the right common carotid vein. The silicone intraluminal stent was placed in the lumen of the jejunal segment and was removed the fourth week after operation. A Ni-Ti alloy prothesis was placed over the jejunal segment, with the mesenteric vascular supply egressing through the longitudinal defect of the mesh tube. Then the free jejunum was used to reconstruct the tracheal defects. Biopsy were performed and recorded at the 1 at, 2nd, 3rd and 4th postoperative months. All specimens were observed by microscope and transmission electron microscope examinations. RESULT: Eight dogs postoperative all survived expected time. One month after operation, the tracheointestinal snastomosis showed smooth and was covered by continuous internal lining. The mucosa of the jejunum was slightly atrophied. Two months after operation, examination of the jejunal mucosa of the autografts demonstrated obviously thinned. The lumen of the reconstructed trachea was covered by squamous epithelium entirely at 3 months postoperatively. The partial squamous epithelium has transformed ciliated columnar epithelium at 4 months postoperatively. CONCLUSION A free scraped partial jejunum reconstructed trachea can accelerated the atrophying process of mucous epithelization and promoted mucosal metaplasia of the jejunum. The reconstructed tracheal lumen has completely transformed squamous epithelium at 3 months postoperatively and partial squamous epithelium has transformed ciliated columnar epithelium at 4 months postoperatively.
Animals ; Atrophy ; pathology ; Autografts ; Dogs ; Epithelium ; Intestinal Mucosa ; pathology ; transplantation ; Jejunum ; pathology ; transplantation ; Mucous Membrane ; pathology ; transplantation ; Nickel ; Reconstructive Surgical Procedures ; Stents ; Surgical Mesh ; Titanium ; Trachea ; surgery ; Transplantation, Autologous

BACKGROUND: Ischemic injury and the rejection process are the main reasons for graft failure in tracheal transplantation models. To enhance the acceptance, we investigated the influence of mesenchymal stem cells (MSCs) on tracheal allografts. METHODS: Extracted tracheal grafts from New Zealand white rabbits were cryopreserved for 4 weeks and orthotopically transplanted (control group A, n=8). In group B (n=8), cyclosporin A (CsA, 10 mg/kg) was injected daily into the peritoneal cavity. In group C (n=8), MSCs (1.0x10(7) cells/kg) from the same donor of the tracheal allograft, which had been pre-cultured for 4 weeks, were infused intravenously after transplantation. In group D (n=8), MSCs were infused and CsA was injected daily. Four weeks after transplantation, gross and histomorphological assessments were conducted for graft necrosis, measuring the cross-sectional area of the allograft, determining the degree of epithelization, lymphocytic infiltration, and vascular regeneration. RESULTS: The morphologic integrity of the trachea was retained completely in all cases. The cross-sectional areas were decreased significantly in group A (p=0.018) and B (p=0.045). The degree of epithelization was enhanced (p=0.012) and the lymphocytic infiltration was decreased (p=0.048) significantly in group D compared to group A. The degree of vascular regeneration did not differ significantly in any of the groups. There were no significant correlations among epithelization, lymphocytic infiltration, and vascular regeneration. CONCLUSION: The administration of MSCs with concurrent injections of CsA enhanced and promoted epithelization and prevented lymphocytic infiltration in tracheal allografts, allowing for better acceptance of the allograft.
Cryopreservation ; Cyclosporine ; Mesenchymal Stromal Cells ; Necrosis ; Peritoneal Cavity ; Rabbits ; Regeneration ; Rejection (Psychology) ; Tissue Donors ; Trachea ; Transplantation, Homologous ; Transplants

PURPOSE: This study was performed to evaluate the long-term effects and safety of intratracheal (IT) transplantation of human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in neonatal hyperoxic lung injury at postnatal day (P)70 in a rat model. MATERIALS AND METHODS: Newborn Sprague Dawley rat pups were subjected to 14 days of hyperoxia (90% oxygen) within 10 hours after birth and allowed to recover at room air until sacrificed at P70. In the transplantation groups, hUCB-MSCs (5x10(5)) were administered intratracheally at P5. At P70, various organs including the heart, lung, liver, and spleen were histologically examined, and the harvested lungs were assessed for morphometric analyses of alveolarization. ED-1, von Willebrand factor, and human-specific nuclear mitotic apparatus protein (NuMA) staining in the lungs and the hematologic profile of blood were evaluated. RESULTS: Impaired alveolar and vascular growth, which evidenced by an increased mean linear intercept and decreased amount of von Willebrand factor, respectively, and the hyperoxia-induced inflammatory responses, as evidenced by inflammatory foci and ED-1 positive alveolar macrophages, were attenuated in the P70 rat lungs by IT transplantation of hUCB-MSCs. Although rare, donor cells with human specific NuMA staining were persistently present in the P70 rat lungs. There were no gross or microscopic abnormal findings in the heart, liver, or spleen, related to the MSCs transplantation. CONCLUSION: The protective and beneficial effects of IT transplantation of hUCB-MSCs in neonatal hyperoxic lung injuries were sustained for a prolonged recovery period without any long-term adverse effects up to P70.
Animals ; *Cord Blood Stem Cell Transplantation ; Ectodysplasins/metabolism ; Humans ; Hyperoxia/*pathology ; Lung/metabolism/pathology ; Lung Injury/pathology/*surgery ; *Mesenchymal Stem Cell Transplantation ; Models, Animal ; Nuclear Matrix-Associated Proteins/metabolism ; Rats ; Trachea/*transplantation ; von Willebrand Factor/metabolism

trachea, larynx, and vascularized joint have been performed. Although composite tissue allografts are still in their infancy, they have opened a new era in the field of transplantation surgery and pathology, so that maxillofacial reconstructive surgeons may occasionally be faced with the challenge of diagnosing skin refection of a composite tissue allograft. Facial allotransplantation (FAT) is a new surgical technique that could be considered as a new paradigm in facial reconstruction. Since the first human FAT had been achieved in 2005, 17 cases have been reported in the world up to date. However, many problems such as life-long immunosuppression, immune rejection, ethical problems and psychological problems are remained, so facial CTA is new reconstructive option with no general acceptance. The authors reviewed the indications, the results of 17 cases and their complications, and additional consideration factors in this article, and intended to raise the awareness of oral and maxillofacial surgeons in this type of facial transplantation.]]>
Animals ; Extremities ; Facial Transplantation ; Hand ; Humans ; Immunosuppression ; Joints ; Larynx ; Rats ; Rejection (Psychology) ; Skin ; Trachea ; Transplantation, Homologous ; Transplants

According to the numerous experimental studies but limited clinical applications, the tracheal replacement is still far to be applied maturely. This should be attribute to the poor biocompatibility of the substitute and insufficient vascularization, even with added prosthetic migration and dislocation, epithelial ischemia and necrosis, as well as local infections, and so on. Here we present a review in the attempts to summarize the progress and prospective advances in tracheal substitute.
Humans ; Prostheses and Implants ; Tissue Engineering ; Tissue Transplantation ; Trachea ; surgery

OBJECTIVETo observe the homing and differentiation of marrow-derived mesenchymal stem cells (MSC) transplanted intravenously in smoke inhalation injured rabbits.

METHODSThirty-two New Zealand big ear rabbits were divided into normal control group (NC), inhalation injury group (II), normal control + MSC treatment group (NM), and MSC treatment group (MT) according to the random number table, with 8 rabbits in each group. Rabbits in NC group were injected with 10 mL phosphate buffered saline (PBS) via ear marginal vein. Rabbits in NM group were injected with 10 mL PBS containing the third generation MSC labeled by BrdU (1 × 10(7) per 10 mL PBS) via ear marginal vein. Severe smoke inhalation injury model was reproduced in the other two groups, among them rabbits in II group were treated as rabbits in NC group, rabbits in MT group treated as rabbits in NM group. On the 7th and 28th day post treatment (PTD), lung tissue and trachea tissue were harvested from four groups for observation on injury with HE staining. Homing of MSC in injured tissue was observed with immunohistochemistry staining. The differentiation of MSC into functional cells was observed with immunohistochemical double staining of combining nuclear marker BrdU with lung (trachea) membrane-specific marker aquaporin-5 (AQP-5), alkaline phosphatase (AKP), CD34, and cytokeratin respectively.

RESULTS(1) MSC homing in lung and trachea tissue was observed in MT group on PTD 7, which was not observed in NM group. (2) AQP-5, AKP, and CD34 positive MSC were observed in lung tissue in MT group on PTD 28, while cytokeratin positive MSC was not observed in trachea tissue. No positively marked MSC was observed in NM group. (3) Injury in lung and trachea was less severe in MT group than in II group; and the proliferation of fibroblasts was less in MT group.

CONCLUSIONSIntravenous injection of MSC to rabbits with smoke inhalation injury can migrate to lung and trachea tissue at obviously inflammatory site, and differentiate into alveolar epithelial cells typeI and II, and pulmonary vascular endothelial cells, which may participate in the process of tissue repair in smoke inhalation injury.

Animals ; Bone Marrow Cells ; cytology ; Cell Differentiation ; Cells, Cultured ; Endothelial Cells ; cytology ; Epithelial Cells ; cytology ; Lung ; cytology ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; cytology ; Pulmonary Alveoli ; cytology ; Rabbits ; Smoke Inhalation Injury ; pathology ; Trachea ; cytology

OBJECTIVE: To investigate the effect of the musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum on the reconstruction of extensiveness laryngotracheal defect. METHOD: Retrospectively studied 49 patients, who admitted in our department from 1996 to 2005 years for severe laryngotracheal defect. There were 28 males and 21 females aged from 15 to 69 years old (mean age was 47 years old). The causes of laryngotracheal defect were laryngotracheal stenosis (31 cases) and surgery for thyroid carcinoma invading trachea (18 cases). All of 49 cases were treated with the graft of musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum and placed a silicon T-tube stenting for 3 to 6 months. RESULT: All of 49 cases were successfully decannulated with recuperative normal airway patency and effective phonation. The follow up ranged from 2 to 10 years, and the effect of operation was steady. CONCLUSION The musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum is an ideal graft for the reconstruction of cervical extensiveness tracheal defect.
Adolescent ; Adult ; Aged ; Female ; Humans ; Laryngostenosis ; surgery ; Male ; Middle Aged ; Periosteum ; transplantation ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Surgical Flaps ; Trachea ; surgery ; Young Adult