Removal of cartilage rings of the graft and omentopexy for extended tracheal autotransplantation

Background. One of the serious problems in longer-size tracheal transplantation is infection or severe stenosis of the graft, probably caused by an inadequate blood supply even with omentopexy. For obtaining an appropriate blood supply, we experimentally developed a new technique that included removal of some cartilage rings of the graft and omentopexy. Methods. Twenty-one adult mongrel dogs were used. In group A (n = 11), a nine-cartilage ring length of the trachea in which six of nine rings were removed, leaving one cartilage ring at each end of the graft and another in the center, was autotransplanted with omentopexy. Two artificial tracheal rings outside the graft were used for maintaining the lumen. In group B (n = 10), a nine-cartilage ring length of the trachea was autotransplanted with omentopexy. Results. In group A, all dogs survived until being sacrificed, whereas 5 group B dogs died of graft infection and mediastinitis (p< 0.05 versus group A). Mucosal blood flow of the graft in group A was normal and higher than in group B (p< 0.05). Grade of the graft stenosis at death or sacrifice was 14% ± 1% in group A and 58% ± 25% in group B (p< 0.05). Conclusions. Removal of some cartilage rings improved blood supply to the graft and resulted in satisfactory survival and nonsignificant tracheal stenosis in extended tracheal autotransplantation.