Ch'ng Sydney, Wong Gerald L, Clark Jonathan R
Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Department of Anesthesia, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
J Reconstr Microsurg. 2014 Mar;30(3):153-62. doi: 10.1055/s-0033-1358786. Epub 2013 Dec 12.
This article reviews established methods of autologous tracheal reconstruction, the various synthetic prostheses that have been used in clinical practice, and briefly describes the latest developments in stem cell tracheal bioengineering and allogeneic tracheal transplantation. Reconstruction of the trachea is challenging due to its part cervical part thoracic location, proximity to major vessels, variable blood supply, and its constant colonization with bacteria. In cases of limited resection, primary anastomosis, autologous patch grafts, local advancement rotation flaps, and locoregional cutaneous and muscle flaps will often suffice. In more extensive resections, complex composite microsurgical reconstruction with a radial forearm free flap with cartilage grafts for skeletal support has proven to be viable and reliable. Synthetic tracheal prostheses, solid as well as porous, have been trialed with disappointing results. Infection, dislodgement, migration, and obstruction are not uncommon. Reconstruction with the cadaveric tracheal allografts and aortic allografts continue to be fraught with complications, specifically graft infections. Tracheal bioengineering and tracheal allotransplantation have emerged relatively recently. Despite early promising results, long-term outcome data on these new techniques are still lacking.
本文回顾了自体气管重建的既定方法、临床实践中使用过的各种合成假体，并简要描述了干细胞气管生物工程和同种异体气管移植的最新进展。气管重建具有挑战性，这是由于其部分位于颈部、部分位于胸部，靠近大血管，血供多变，且经常被细菌定植。在切除范围有限的情况下，一期吻合、自体补片移植、局部推进旋转皮瓣以及局部皮肤和肌肉皮瓣通常就足够了。在更广泛的切除中，采用带软骨移植的桡侧前臂游离皮瓣进行复杂的复合显微外科重建已被证明是可行且可靠的。固体和多孔的合成气管假体都曾进行过试验，但结果令人失望。感染、移位、迁移和阻塞并不罕见。尸体气管同种异体移植和主动脉同种异体移植重建仍然充满并发症，特别是移植物感染。气管生物工程和气管同种异体移植相对较新才出现。尽管早期结果令人鼓舞，但这些新技术的长期结果数据仍然缺乏。
