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Ann Thorac Surg 1999;67:1215-1216
© 1999 The Society of Thoracic Surgeons

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Correspondence

Tracheal prostheses

^a Department of Thoracic Surgery, Marmara University, Medical Faculty, PK 97, 81020, Acibadem, Istanbul, Turkey

To the Editor

Using the highly developed techniques of tracheal surgery, it is currently possible to resect and reconstruct more than 50% of the human trachea [1]. On the other hand, in cases with extensive organ involvement as in cases of a large tumor or multifocal diseases such as fistulas, strictures, and tracheomalasia, organ replacement with prosthesis become necessary.

Up to now myriad experimental studies have been tried to develop a suitable prosthetic material to replace trachea in every aspect. Unfortunately none of them was adequate for acceptance as an ideal tracheal prosthesis, which should be inert; should allow tissue ingrowth, not collapse; should allow development of respiratory mucosa; should be airtight; and should be resistant to infection and extrusion [2].

Doctor Jorge and colleagues [3] reported the use of a polytetrafluoroethylene (PTFE) graft with a better success in the laser-irradiated group. If the recent improvements in laser myocardial revascularization are considered, this outcome is not surprising. On the other hand, Jorge and associates also emphasize the role of microporosity of PTFE with a pore diameter of 30 µm for tracheal replacement purposes. They claim that a 30-µm pore size, besides being airtight, is big enough for tissue ingrowth.

Kaiser [4] reported the use of Dacron implants in a similar experiment in dogs. He used low porosity (25 to 50 µm) and high porosity (125 to 150 µm) Dacron implants. Although graft extrusion with no tissue incorporation was observed with the use of low-porosity implants, with the use of high-porosity Dacron implants, good tissue incorporation was observed. He also reported no air leak after a small surface support by 1 mL of fibrin adhesive. This obviously shows that a bigger pore size does not pose a problem with air leaks and it facilitates the tissue ingrowth to a greater extent.

Another prerequisite for an ideal prosthetic material is providing an inner covering of the prosthesis with a ciliated respiratory epithelium. Although Jorge and coworkers [3] reported an epithelial covering of the inner prosthetic surface, they do not mention the type of the epithelium. As is well known, the ciliated respiratory epithelium has unique functions, such as cephalad beating movements enabling the expectoration of microorganisms and foreign particles. Whereas most prosthetic materials are covered, if at all, by squamous epithelium, this covering lacks the cilia function. With the use of a high-porosity Dacron prosthesis, Kaiser [4] also reported a ciliated epithelium covering the inner surface of the graft as early as the 90th day after implantation. Therefore, not tightly woven, but knitted Dacron may be a better option for the prosthetic replacement of the trachea.

References

1. Grillo H., Dignan E.F., Miura Y. Extensive resection and reconstruction of mediastinal trachea without prosthesis or graft: an anatomical study in man. J Thorac Cardiovasc Surg 1964;48:741-749.
2. Greve H. Substitution of the wall of the trachea by absorbable synthetic material. Thorac Cardiovasc Surgeon 1988;36:20-26.[Medline]
3. Jorge R.G., Ramos S.P., de Guevara A.C.L., et al. Experimental study of a new porous tracheal prosthesis. Ann Thorac Surg 1998;65:1830-1831.[Free Full Text]
4. Kaiser D. Alloplastic replacement of canine trachea with Dacron. Thorac Cardiovasc Surgeon 1985;33:239-243.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sina Ercan Mustafa Yüksel Hasan F. Batirel Bedrettin Yildizeli Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ercan, S. Articles by Yildizeli, B. Search for Related Content PubMed Articles by Ercan, S. Articles by Yildizeli, B.