Successful tracheal autotransplantation with two-stage approach using the greater omentum

Background. Although many studies on reconstruction of extensive circumferential tracheal defects with a segmental trachea have been done, up to date, no reliable and satisfactory tracheal transplantation procedure has been developed. We conducted this experiment to investigate feasibility and efficacy of a staged tracheal transplantation approach for tracheal reconstruction. Methods. Twelve dogs were divided equally into groups I and II. A segment of cervical tracheas (six rings) was harvested as an autograft and implanted heterotopically into the greater omentum. Two weeks later, the autografts with their omental pedicles were transplanted orthotopically to the cervical (group I) or the thoracic portion of the trachea (group II). Bronchoscopic examination were performed monthly during a 5-month follow-up period. After sacrificing the dogs, we had the grafts examined macroscopically and microscopically. Results. The dogs of both groups survived well until the end of the follow-up. No abnormal findings were observed through bronchoscopy. The grafts had normal appearance, without shrinkage, granulation, or necrosis by postmortem gross examination. Histologic examination showed the structures of the grafts were intact. Conclusions. We conclude that the two-stage tracheal transplantation approach using the greater omentum is feasible, and can facilitate the survival of a tracheal graft as well.