Tracheal reconstruction with a free vascularized myofascial flap: Preclinical investigation in a porcine model to human clinical application

Won Shik Kim, Jae Won Chang, Woo Soon Jang, Young Joon Seo, Mi Lan Kang, Hak Joon Sung, Da Hee Kim, Jung Min Kim, Jae Hong Park, Myung Jin Ban, Gina Na, Seung Ho Shin, Hyung Kwon Byeon, Yoon Woo Koh, Se Heon Kim, Hong Koo Baik, Eun Chang Choi

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Abstract

Although there are various methods for tracheal reconstruction, such as a simple approximation with suturing and coverage with adjacent soft tissue or muscle, large defects >50% of the tracheal length still present a clinical challenge. Tissue engineering, a recent promising way to possibly resolve this problem, requires a long preparatory period for stem cell seeding on a scaffold and relatively invasive procedures for stem cell harvesting. As an alternative, we used a vascularized myofascial flap for tracheal reconstruction. In four porcine models, the deep inferior epigastric perforator (DIEP) was used in two and the superior epigastric artery perforator (SEAP) in two. Transformation of the surface of the transplanted myofascial flap was analyzed in the airway environment. The flaps failed in the DIEP group due to venous congestion. At 12 weeks postoperatively, none of SEAP group showed any signs of respiratory distress; the inner surface of the implant exhibited stratified squamous epithelium with sparse cilia. In the clinical setting, a patient who underwent a tracheal reconstruction with a vascularized myofascial flap and 2-year follow-up was in good health with no respiratory distress symptoms.

Original languageEnglish
Article number10022
JournalScientific reports
Volume7
Issue number1
DOIs
Publication statusPublished - 2017 Dec 1

All Science Journal Classification (ASJC) codes

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    Kim, W. S., Chang, J. W., Jang, W. S., Seo, Y. J., Kang, M. L., Sung, H. J., Kim, D. H., Kim, J. M., Park, J. H., Ban, M. J., Na, G., Shin, S. H., Byeon, H. K., Koh, Y. W., Kim, S. H., Baik, H. K., & Choi, E. C. (2017). Tracheal reconstruction with a free vascularized myofascial flap: Preclinical investigation in a porcine model to human clinical application. Scientific reports, 7(1), [10022]. https://doi.org/10.1038/s41598-017-10733-z