Artif Organs. 2021 Jul 26. doi: 10.1111/aor.14043. Online ahead of print.
ABSTRACT
INTRODUCTION: In tracheal replacement transplantation, prelamination is a critical stage. Nowadays, the most widely used prelamination technique is the prethoracic fascia flap with lateral thoracic artery. We propose a flap based on the internal thoracic artery, which allows a relatively non-aggressive double organ implant, and we have tested its efficacy in decellularized tracheas.
MATERIAL AND METHODS: Tracheas of albino New Zealand rabbits were decellularized following a protocol that uses detergents and cryogenization, sterilized with 1kGy gamma radiation and tutorized with a stent. Bilateral pedicled flaps made of pectoral fascia and a muscular component were harvested through a longitudinal 3-cm central thoracic incision, wrapping the tracheas with them in 16 rabbits, remaining them implanted for 2, 4, 8 and 12 weeks. The tracheas were then studied histologically using standard stainings plus immunohistochemistry (CD31). The models were adjusted with Bayesian statistics using ordinal regression; results as odds ratios and credibility intervals. All analysis were performed using R software.
RESULTS: Acute inflammatory cell invasion was observed at 2 weeks, which almost disappeared in the week 8 after implant. Only macrophages and giant cells increased between weeks 8 and 12 (OR 10.487, IC [1.603-97.327]). The cartilage maintained its structure, with slight signs of ischemia in a few cases. New CD31-positive vessels were observed from week 2 and increasing thereafter, reaching a maximum peak at week 8.
CONCLUSION: We propose a bilateral implant technique that is viable and effective as a prelamination option for two concurrent tracheas, achieving perfect vascularization and integration of the organ with hardly any inflammatory response in the medium- or long-term.
PMID:34310703 | DOI:10.1111/aor.14043
