11. Pediatric Tracheal Homograft Reconstruction: A Novel Approach To Complex Tracheal Stenoses

Jeffrey P. Jacobs, Redmond P. Burke, Martin Elliott, Claus Herberhold

All Children’s Hospital, Miami Children’s Hospital, Great Ormond Street, University of Bonn

St. Petersburg, Fla., Miami, Fla., London, England, Bonn, Germany

Purpose: Tracheal stenosis can be a life-threatening problem. Long segment tracheal stenosis and recurrent tracheal stenosis are especially problematic. Tracheal homograft reconstruction [THR] represents a novel therapeutic modality for these patients.

Methods: Cadaveric trachea is harvested, fixed in formalin, washed in methiolate, and stored in acetone. The stenosed tracheal segment is opened to widely patent segments proximally and distally. The anterior cartilage is incised and the posterior trachealis muscle or tracheal wall remains. A temporary silastic intraluminal stent is placed and absorbable sutures secure the homograft. Regular postoperative bronchoscopy clears granulation tissue. The stent is removed endoscopically after epithelialization over the homograft. Twenty-eight children aged five months to 18 years (and 122 adults) with severe long segment tracheal stenosis have undergone THR.

Results: In children, follow-up ranged from five months to 10 years. Twenty-three children survive (23/28 = 82 percent). Three patients died early: two due to bleeding and one from mediastinitis. Two patients with functional airways died late from unrelated problems. All 23 survivors are free from tracheotomies.

Conclusions: THR demonstrates encouraging short to medium-term results for children with severe recurrent tracheal stenosis. Postoperative bronchoscopic and histologic studies provide evidence of epithelialization and support the expectation of good long-term results.