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Lin H, Ainiwaer M, Jiang Z, Wang Z, Liu J, Chen F. Comparative evaluation of mechanical injury methods for establishing stable tracheal stenosis animal models. Sci Rep 2024; 14:2383. [PMID: 38287058 PMCID: PMC10824766 DOI: 10.1038/s41598-024-52230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
The study aimed to assess the stability of various mechanical injury techniques in creating tracheal stenosis animal models using endoscopic assistance and investigate the viability of tracheal stoma in this process. Twenty-six healthy adult New Zealand white rabbits were randomly assigned to an experimental and control group. The experimental group underwent tracheal incision followed by steel brush scraping with endoscopic assistance, while the control group received nylon brush scraping. Within the control group, two subgroups were formed: Group A underwent scraping without tracheal stoma, and Group B underwent scraping followed by tracheal stoma. Additionally, a sham operation was performed on a separate group without subsequent scratching, resulting in no stenosis formation. Endoscopic observations were conducted at 7, 14, and 21 days post-scraping, followed by histological examinations of euthanized rabbits on the 21st day. Notably, all rabbits in the non-stoma group survived without complications, whereas Group B rabbits faced mortality post-operation. Histological assessments revealed inflammatory cell infiltration, fibroblast proliferation, and collagen fiber deposition in narrowed tracheal specimens. Steel brush scraping with endoscopic assistance proved more effective in inducing stable tracheal stenosis compared to nylon brush scraping. However, the survival challenges of rabbits with tracheal fistula require further investigation.
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Affiliation(s)
- Hongbin Lin
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Department of Otolaryngology-Head and Neck Surgery, The Third People's Hospital of Sichuan Province, Chengdu, China
| | - Mailudan Ainiwaer
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zheng Jiang
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zhenyan Wang
- Department of Otolaryngology-Head and Neck Surgery, The Third People's Hospital of Sichuan Province, Chengdu, China.
| | - Jun Liu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Fei Chen
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Bellia-Munzon G, Cieri P, Toselli L, Cuestas G, Doormann F, Gabaldón-Massé P, Rodriguez V, Bellia-Munzon P. Resorbable airway splint, stents, and 3D reconstruction and printing of the airway in tracheobronchomalacia. Semin Pediatr Surg 2021; 30:151063. [PMID: 34172216 DOI: 10.1016/j.sempedsurg.2021.151063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tracheobronchomalacia (TBM) is the most common tracheobronchial obstruction. Most cases are mild to moderate; therefore, they do not need surgical treatment. Severe tracheomalacia, however, represents a diagnostic and therapeutic challenge since they are very heterogeneous. In the armamentarium of resources for the treatment of dynamic airway collapse, splints and stents are two underused strategies and yet, they may represent the best alternative in selected cases. Lately, computed tomography 3D reconstruction of the airway has been used for the design of virtual models that can be 3D-printed for the creation of novel devices to address training, simulation, and biotechnological implants for refractory and severe airway malformations. This manuscript examines the role of resorbable stents, splints, and the 3D reconstruction and printing of the pediatric airway in tracheobronchomalacia.
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Affiliation(s)
- Gaston Bellia-Munzon
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Patricio Cieri
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina..
| | - Luzia Toselli
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Giselle Cuestas
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Flavia Doormann
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Paula Gabaldón-Massé
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Verónica Rodriguez
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Patricio Bellia-Munzon
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.; Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
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Wineland AM. Surgical management of an infantile elliptical cricoid: Endoscopic posterior laryngotracheoplasty utilizing a resorbable plate. Int J Pediatr Otorhinolaryngol 2020; 138:110285. [PMID: 32795728 DOI: 10.1016/j.ijporl.2020.110285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
The cricoid is a circular "ring" of cartilage in the airway. When the lateral walls of the cricoid approximate, it takes the shape of an ellipse. In severe cases, this also reduces the glottic aperture and causes respiratory distress, stridor, and failure to thrive. The elliptical cricoid has limited surgical options outside of open laryngotracheal procedures and tracheostomy. Recently, alternatives to autologous grafts have been utilized in airway reconstruction to reduce harvest site morbidity and increase operating room efficiency. Herein a case is presented that demonstrates the successful use of a resorbable plate in augmenting the posterior larynx in an infant with a severely elliptical cricoid to avoid a tracheostomy.
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Affiliation(s)
- Andre' M Wineland
- University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 836, Little Rock, AR, 72202, USA.
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Frejo L, Grande DA. 3D-bioprinted tracheal reconstruction: an overview. Bioelectron Med 2019; 5:15. [PMID: 32232104 PMCID: PMC7098220 DOI: 10.1186/s42234-019-0031-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
Congenital tracheomalacia and tracheal stenosis are commonly seen in premature infants. In adulthood, are typically related with chronic obstructive pulmonary disease, and can occur secondarily from tracheostomy, prolong intubation, trauma, infection and tumors. Both conditions are life-threatening when not managed properly. There are still some surgical limitations for certain pathologies, however tissue engineering is a promising approach to treat massive airway dysfunctions. 3D-bioprinting have contributed to current preclinical and clinical efforts in airway reconstruction. Several strategies have been used to overcome the difficulty of airway reconstruction such as scaffold materials, construct designs, cellular types, biologic components, hydrogels and animal models used in tracheal reconstruction. Nevertheless, additional long-term in vivo studies need to be performed to assess the efficacy and safety of tissue-engineered tracheal grafts in terms of mechanical properties, behavior and, the possibility of further stenosis development.
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Affiliation(s)
- Lidia Frejo
- Orthopaedic Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030 USA
- Division of Otolaryngology and Communicative Disorders-Pediatric Otolaryngology, Long Island Jewish Medical Center New Hyde Park, New York, USA
| | - Daniel A. Grande
- Orthopaedic Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030 USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Employing bioabsorbable grafts in two-stage laryngotracheal reconstruction of pediatric patient with severe subglottic stenosis and history of airway surgery. Int J Pediatr Otorhinolaryngol 2018; 115:58-60. [PMID: 30368394 DOI: 10.1016/j.ijporl.2018.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/16/2018] [Accepted: 09/16/2018] [Indexed: 11/23/2022]
Abstract
A 16-month old female was referred to our practice for laryngotracheal reconstruction (LTR) for acquired subglottic stenosis (SGS) diagnosed at 4 weeks of age due to prolonged intubation. She has a history of open thoracic repair of congenital tracheoesophageal fistula that was complicated by a pneumothorax and phrenic nerve paralysis. We performed a variation of an anterior and posterior cricoid split LTR with tracheal stenting in order to avoid risks of pulmonary morbidity from costochondral cartilage harvesting. We report the first LTR to use KLS Martin Resorb-XG bioabsorbable implant (poly-L-lactic acid & poly glycolic acid) as a substitute graft for autologous cartilage in a patient with severe SGS and a history of airway surgeries. The patient had an uncomplicated recovery and had a patent trachea on laryngobronchoscopy at 4, 13, and 22 months after surgery.
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Goldstein TA, Smith BD, Zeltsman D, Grande D, Smith LP. Introducing a 3-dimensionally Printed, Tissue-Engineered Graft for Airway Reconstruction. Otolaryngol Head Neck Surg 2015; 153:1001-6. [DOI: 10.1177/0194599815605492] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/21/2015] [Indexed: 12/19/2022]
Abstract
Objective: To use 3-dimensional (3D) printing and tissue engineering to create a graft for laryngotracheal reconstruction (LTR). Study Design: In vitro and in vivo pilot animal study. Setting: Large tertiary care academic medical center. Subjects and Methods: A 3D computer model of an anterior LTR graft was designed. That design was printed with polylactic acid on a commercially available 3D printer. The scaffolds were seeded with mature chondrocytes and collagen gel and cultured in vitro for up to 3 weeks. Scaffolds were evaluated in vitro for cell viability and proliferation. Anterior graft LTR was performed on 9 New Zealand white rabbits with the newly created scaffolds. Three animals were sacrificed at each time point (4, 8, and 12 weeks). The in vivo graft sites were assessed via bronchoscopy and histology. Results: The in vitro cell proliferation assay demonstrated initial viability of 87.5%. The cells proliferated during the study period, doubling over the first 7 days. Histology revealed that the cells retained their cartilaginous properties during the 21-day study period. In vivo testing showed that all animals survived for the duration of the study. Bronchoscopy revealed a well-mucosalized tracheal lumen with no evidence of scarring or granulation tissue. Histology indicated the presence of newly formed cartilage in the region where the graft was present. Conclusions: Our results indicate that it is possible to produce a custom-designed, 3D-printed, tissue-engineered graft for airway reconstruction.
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Affiliation(s)
- Todd A. Goldstein
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Orthopaedic Research Laboratory, Feinstein Institute of Medical Research, Manhasset, New York, USA
| | - Benjamin D. Smith
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Orthopaedic Research Laboratory, Feinstein Institute of Medical Research, Manhasset, New York, USA
| | - David Zeltsman
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Department of Cardiovascular and Thoracic Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Daniel Grande
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Orthopaedic Research Laboratory, Feinstein Institute of Medical Research, Manhasset, New York, USA
| | - Lee P. Smith
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Division of Pediatric Otolaryngology, Steven and Alexandra Cohen Children’s Medical Center, New Hyde Park, New York, USA
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He X, Fu W, Zheng J. Cell sources for trachea tissue engineering: past, present and future. Regen Med 2013; 7:851-63. [PMID: 23164084 DOI: 10.2217/rme.12.96] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Trachea tissue engineering has been one of the most promising approaches to providing a potential clinical application for the treatment of long-segment tracheal stenosis. The sources of the cells are particularly important as the primary factor for tissue engineering. The use of appropriate cells seeded onto scaffolds holds huge promise as a means of engineering the trachea. Furthermore, appropriate cells would accelerate the regeneration of the tissue even without scaffolds. Besides autologous mature cells, various stem cells, including bone marrow-derived mesenchymal stem cells, adipose tissue-derived stem cells, umbilical cord blood-derived mesenchymal stem cells, amniotic fluid stem cells, embryonic stem cells and induced pluripotent stem cells, have received extensive attention in the field of trachea tissue engineering. Therefore, this article reviews the progress on different cell sources for engineering tracheal cartilage and epithelium, which can lead to a better selection and strategy for engineering the trachea.
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Affiliation(s)
- Xiaomin He
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai 200127, China
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Javia LR, Zur KB. Laryngotracheal reconstruction with resorbable microplate buttressing. Laryngoscope 2012; 122:920-4. [DOI: 10.1002/lary.23224] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 12/16/2011] [Accepted: 01/05/2012] [Indexed: 11/08/2022]
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Rickert D. Polymeric implant materials for the reconstruction of tracheal and pharyngeal mucosal defects in head and neck surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 8:Doc06. [PMID: 22073099 PMCID: PMC3199816 DOI: 10.3205/cto000058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The existing therapeutical options for the tracheal and pharyngeal reconstruction by use of implant materials are described. Inspite of a multitude of options and the availability of very different materials none of these methods applied for tracheal reconstruction were successfully introduced into the clinical routine. Essential problems are insufficiencies of anastomoses, stenoses, lack of mucociliary clearance and vascularisation. The advances in Tissue Engineering (TE) offer new therapeutical options also in the field of the reconstructive surgery of the trachea. In pharyngeal reconstruction far reaching developments cannot be recognized at the moment which would allow to give a prognosis of their success in clinical application. A new polymeric implant material consisting of multiblock copolymers was applied in our own work which was regarded as a promising material for the reconstruction of the upper aerodigestive tract (ADT) due to its physicochemical characteristics. In order to test this material for applications in the ADT under extreme chemical, enzymatical, bacterial and mechanical conditions we applied it for the reconstruction of a complete defect of the gastric wall in an animal model. In none of the animals tested either gastrointestinal complications or negative systemic events occurred, however, there was a multilayered regeneration of the gastric wall implying a regular structured mucosa. In future the advanced stem cell technology will allow further progress in the reconstruction of different kind of tissues also in the field of head and neck surgery following the principles of Tissue Engineering.
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Affiliation(s)
- Dorothee Rickert
- University Hospital and Ambulance for Ear, Nose and Throat Diseases, Ulm, Germany
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Sprecher RC. Single-stage laryngotracheal reconstruction using bioabsorbable miniplates. Laryngoscope 2010; 120:1655-61. [DOI: 10.1002/lary.20744] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lewis AF, Jordan JR, Parsell DE, Kosko M. Comparison of pullout strength of resorbable screws in human cadaveric laryngeal cartilage using different drill diameters. Head Neck 2008; 30:1464-8. [DOI: 10.1002/hed.20890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Otteson TD, Sandulache VC, Barsic M, DiSilvio GM, Hebda PA, Dohar JE. Acute and chronic changes in the subglottis induced by graded carbon dioxide laser injury in the rabbit airway. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 2008; 134:694-702. [PMID: 18645117 PMCID: PMC3000118 DOI: 10.1001/archotol.134.7.694] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the repair process following carbon dioxide laser injury to the upper airway mucosa (UAM) during the development of chronic subglottic stenosis (SGS). DESIGN Animals were assigned to either sham control (cricothyroidotomy only) or injured (cricothyroidotomy and posterior subglottic laser) groups using various carbon dioxide laser exposures (8, 12, and 16 W) for 4 seconds. SUBJECTS Twenty-four New Zealand white rabbits. INTERVENTIONS The subglottis was approached via cricothyroidotomy. Sham control airways were immediately closed, whereas injured airways were subjected to graded carbon dioxide laser exposures prior to closure. Airways were endoscopically monitored preoperatively, postoperatively, and on postoperative days 7, 14, 28, 42, 56, 70, and 84. Animals were killed at 14 and 84 days. Subglottic tissue was harvested for histologic evaluation (reepithelialization, extracellular matrix, vascularity, and inflammation). MAIN OUTCOME MEASURES Endoscopic visualization and histologic analysis. RESULTS (1) Increases in UAM thickness (up to 5 times the thickness of normal mucosa) were observed but were limited primarily to the lamina propria. The mucosal epithelium regenerated without chronic changes. Focal areas of cartilage repair were encountered acutely after injury and to a greater extent in the chronic phases of repair. (2) Acutely, the thickened lamina propria comprised poorly organized extracellular matrix components and demonstrated increases in blood vessel size and number. (3) Histologic changes present in the acute phase only partially resolved in progression to chronic SGS. Chronic SGS was characterized by thick collagen fiber bundles extending into the remodeled subglottic cartilage. CONCLUSIONS The carbon dioxide laser induces acute changes to lamina propria architecture and vascularity that persist chronically. Elucidating responsible signaling pathways may facilitate the development of therapeutic agents to prevent or reduce the formation of SGS.
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Affiliation(s)
- Todd D. Otteson
- Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh
- Department of Otolaryngology, University of Pittsburgh
| | - Vlad C. Sandulache
- Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh
- Department of Otolaryngology, University of Pittsburgh
- Cellular and Molecular Pathology Program, University of Pittsburgh School of Medicine
- McGowan Institute for Regenerative Medicine
| | - Mark Barsic
- Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh
| | | | - Patricia A. Hebda
- Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh
- Department of Otolaryngology, University of Pittsburgh
- Department of Cell Biology and Physiology, University of Pittsburgh
- Cellular and Molecular Pathology Program, University of Pittsburgh School of Medicine
- McGowan Institute for Regenerative Medicine
| | - Joseph E. Dohar
- Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh
- Department of Otolaryngology, University of Pittsburgh
- McGowan Institute for Regenerative Medicine
- Communication Science and Disorders University of Pittsburgh School of Health and Rehabilitation Sciences
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Guerra AB, Miller LA, Soueid NE, Metzinger SE. Laryngotracheal Reconstruction Using a Rigidly Fixated Split Clavicular Myoosseous Flap. Ann Plast Surg 2006; 57:402-7. [PMID: 16998332 DOI: 10.1097/01.sap.0000221502.55707.f0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Huber JE, Spievack A, Simmons-Byrd A, Ringel RL, Badylak S. Extracellular matrix as a scaffold for laryngeal reconstruction. Ann Otol Rhinol Laryngol 2003; 112:428-33. [PMID: 12784982 DOI: 10.1177/000348940311200508] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Porcine-derived xenogeneic extracellular matrix (ECM) has been successfully used as a scaffold for tissue repair and reconstruction in numerous preclinical animal studies and human applications. These scaffolds are completely and rapidly degraded and replaced by host-derived tissues that frequently mimic the original tissue composition and architecture. The purpose of the present study was to examine the morphology of ECM scaffolds after their use for laryngeal reconstruction. Thirty adult female dogs were subjected to a partial hemilaryngectomy. The right thyroid cartilage and vocal fold were replaced with ECM scaffold, and the dogs were painlessly sacrificed from 1 week to 12 months after surgery. Histologic examination of the reconstructed tissue showed the presence of a simple squamous epithelial lining, organized glandular structures within the submucosa, reconstructed thyroid cartilage, and bundles of skeletal muscle by 3 months after surgery. We conclude that ECM scaffolds are promising templates for constructive remodeling of laryngeal tissue.
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Affiliation(s)
- Jessica E Huber
- Department of Audiology and Speech Sciences, Purdue University, West Lafayette, Indiana 47907-2038, USA
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