Repair of subglottic stenosis with a free perichondrial graft

Characterisation of cells in regenerating cartilage from autotransplanted perichondrium. immunohistochemical expression of smooth-muscle actin, desmin, vimentin, and Ki-67

Autotransplanted perichondrium from rib and ear sutured to the knee joints of 26 rabbits has been examined with immunohistochemistry and shows certain structural, functional, and proliferative characteristics of regenerating cartilage. Cryostat sections have been examined for the expression of smooth-muscle actin (SMA), desmin, vimentin, and Ki-67. In this rabbit model of perichondrial grafting SMA staining showed vivid vessel regeneration, particularly in the proliferating stage about two to three weeks after grafting, and no vessels in more mature parts one month or more after transplantation. Desmin staining showed expression and distribution similar to SMA. Vimentin staining shows the cytoskeleton of regenerating cartilaginous tissue and makes cellular borders apparent. Immunohistochemical expression of Ki-67 is constantly negative in perichondrial tissue from rib and ear before transplantation, clearly positive in the proliferative stage, but there is no expression in maturing cartilage. The study also shows that all human antibodies used are applicable in a rabbit model.

Reconstruction of the growing cricoid with a composite graft of demineralized bovine bone and autogenous perichondrium; a comparative study in rabbits

In growing rabbits, the feasibility of a new type of composite graft for the reconstruction of defects in the cricoid ring is studied. This graft consists of Demineralized Bovine Bone matrix (DBBM) enfolded in a perichondrial flap. The cartilage formed in the DBBM by cells, derived from the perichondrium, is demonstrated to provide a valuable substitute for resected parts of the cricoid. A specific feature of this reconstruction is that it allows further growth and does not result in a secondary stenosis during later development.

Repair of subglottic stenosis with a free perichondrial graft

A case of tracheal stenosis was reconstructed, after trough formation, with a chondromucosal flap which was developed by submucous perichondrial grafting. At the first stage, a free perichondrial graft from the pinna was transplanted into the buccal submucosal layer. About 10 months later, when sufficient neocartilage had formed, the chondromucosal composite graft was transferred from the buccal region to the paratracheal subcutaneous region with the mucosa facing deeply. Finally, 4 weeks later the tracheal trough was closed with a composite rotation flap which incorporated the skin, neocartilage and mucosa. The postoperative course was uneventful and a wide tracheal lumen with a firm framework and mucous lining was confirmed by both fibrescopic and radiographic examination.

Experimental laryngeal reconstruction with preformed composite graft

The use of perichondrial grafts for reconstruction of the thyroid cartilage of the larynx was studied in two series of rabbits. In the first pilot study the thyroid cartilage was replaced by a cartilage performed by the neochondrogenic effect of an auricular perichondrial graft set into the defect on a subcutaneous flap. When this transplantation technique proved successful, another series was performed where a laryngeal defect of the thyroid cartilage and the underlying mucosa were replaced by a preformed composite graft. This composite graft consisted of a biological support of newly formed cartilage from the neochondrogenic effect of a free perichondrial graft and mucosal lining made of a retention cyst from a free graft of oral mucosa. The newly formed composite graft was transferred to set into the laryngeal defect on a subcutaneous flap. The reconstruction was successful and all the rabbits survived, with no respiratory distress. The newly formed cartilage offered sufficient support to the reconstructed larynx. The lining formed from the mucosa of the retention cyst consisted of undiffered stratified squamous cells. This lining membrane was sufficient to control the fibrous tissue response and maintain patency of the restored lumen.