Experimental reconstruction of the trachea with urinary bladder wall

Abstract

Purpose: To investigate tracheal reconstruction with autologous bladder wall using modern refined surgical procedures. Methods: Experiments were performed on 16 female beagle dogs. Six tracheal cartilages were resected to create a tracheal deficit, then tracheal replacement with autologous bladder wall was performed. In the first 10 dogs (first series), the transplant site was covered with pedicled omental flap. In the next six dogs (second series), we performed tracheal reconstruction without omental covering, and secured tracheal cartilages above and below the graft with sutures to prevent excessive graft stretching. Results: No surgical mortality or lethal infection of the transplant site was encountered in either series. Complications in the first series comprised tracheal stenosis in four dogs. One dog died suddenly at 4 months postoperatively due to stent migration, so cartilage sutures were adopted in the second series. The lumen surface of the grafts was covered with squamous metaplastic epithelium. Osseous tissue was present in the submucosa of grafts, particularly prominently in areas lacking omental covering. Conclusions: Tracheal reconstruction using bladder wall may become clinically useful. A pedicled omental covering does not appear always necessary to prevent graft necrosis and infection. Ischemic stimulation may be involved with bone formation in grafts.