Experimental Reconstruction Of The Canine Trachea With Free Jejunal Graft Coupled With Titanium-nickel Alloy Mesh

Reconstruction of extensive tracheal defects was still an unsolved problem. There wre many methods of tracheal reconstruction.Among these, the reconstruction of tracheal defects with autologous tissues coupled with prosthetic materials was the most hopeful method to date that would achieved good results in clinical application. The study would use a one-stage technique with free jejunal graft coupled with titanium-nickel alloy mesh to reconstruct the canine trachea for the purpose of providing theoretical and experimental basis for reconstruction of extensive tracheal defects.Objective:To explore the feasibility of the reconstruction of tracheal defects with free jejunal graft coupled with titanium-nickel alloy mesh.Methods : 10 healthy mongrel dogs were divided into two groups randomly,control group including one dog and experimental group including 9 dogs.In two groups,a 5-cm segment of the cervical trachea was resected and replaced by the free jejunal graft through the operation of vascular anastomosis and the"T-shaped"silicone tube was placed into the jejunal lumen as the temporary stent. In experimental group ,the titanium-nickel alloy mesh was placed into the space between the jejunal and the surrounding tissue.But in control group, there was no titanium-nickel alloy mesh implanted. the"T-shaped"silicone tube was removed after a month, and the endoscopic and CT examinations were performed.When the surviving dogs were sacrificed after three and six month postoperatively, macroscopic observation and histological examinations were performed.Results:In control group,endoscopic examination showed enterocinesia and the airway collapsed after extubation.The dog had severe dyspnea and died of asphyxia immediately.In experimental group,one animal died within 24 hours after operation. Endoscopic examination of two animals showed entire necrosis of jejunal graft and the titanium-nickel alloy mesh was exposed in the airway. Endoscopic examination of two animals showed partial necrosis in the tracheointestinal anastomosis. Endoscopic exarmnation of the other four animals showed the jejunal graft surviving and no evidence of enterocinesia and proliferation of granulation at the tracheointestinal anastomosis sites.CT showed that the new airway of the four dogs were wide enough for breath.All animals have cough during 1-2 months after operation. No one died of pneumonia result from hypersecretion.Conclusions:Reconstruction of the canine trachea with free jejunal graft coupled with titanium-nickel alloy mesh can achieve the objective of tracheal reconstruction.But we should be circumspect in clinical application of this method.