Zhang Yiyuan, Wei Shixiong, Li Mingqian, Lv Guoyue
Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China.
Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China.
Front Bioeng Biotechnol. 2024 Aug 21;12:1452780. doi: 10.3389/fbioe.2024.1452780. eCollection 2024.
Tracheal defects, particularly those extending over long segments, present substantial challenges in reconstructive surgery due to complications in vascularization and integration with host tissues. Traditional methods, such as extended tracheostomies and alloplastic stents, often result in significant morbidity due to mucus plugging and mechanical erosion. Recent advances in vascularized composite allograft (VCA) transplantation have opened new avenues for effective tracheal reconstruction. This article reviews the evolution of tracheal reconstruction techniques, focusing on the shift from non-vascularized approaches to innovative revascularization methods that enhance graft integration and functionality. Key advancements include indirect revascularization techniques and the integration of regenerative medicine, which have shown promise in overcoming historical barriers to successful tracheal transplantation. Clinical case studies are presented to illustrate the complexities and outcomes of recent tracheal transplantation procedures, highlighting the potential for long-term success through the integration of advanced vascular engineering and immune modulation strategies. Furthermore, the role of chimerism in reducing graft rejection and the implications for future tracheal transplantation and tissue engineering efforts are discussed. This review underscores the transformative potential of VCA in tracheal reconstruction, paving the way for more reliable and effective treatments for extensive tracheal defects.
气管缺损，尤其是那些累及长节段的缺损，由于血管化及与宿主组织整合方面的并发症，在重建手术中面临重大挑战。传统方法，如延长气管造口术和异体塑料支架，往往因黏液堵塞和机械侵蚀而导致显著的发病率。血管化复合组织异体移植（VCA）的最新进展为有效的气管重建开辟了新途径。本文回顾了气管重建技术的发展历程，重点关注从非血管化方法向创新的血管再通方法的转变，这些方法可增强移植物的整合和功能。关键进展包括间接血管再通技术和再生医学的整合，它们在克服成功进行气管移植的历史障碍方面显示出前景。本文展示了临床病例研究，以说明近期气管移植手术的复杂性和结果，强调通过整合先进的血管工程和免疫调节策略实现长期成功的潜力。此外，还讨论了嵌合体在减少移植物排斥反应中的作用以及对未来气管移植和组织工程工作的影响。本综述强调了VCA在气管重建中的变革潜力，为广泛气管缺损的更可靠、有效的治疗铺平了道路。
