LECTURE
Lecture topic: Tracheal allograft use in Otolaryngology surgery:
Tracheal ring implants can be used in for Otolaryngology surgery.
Etiology: congenital, intubation, tracheostomy, trauma, chemical, infection. But intubation is most common.
Incidence of tracheal stenosis:
Intubation > 10 days = 14%
Management: conservative, open surgery
Conservative:
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Tracheostomy |
Broncoscopic dilation with or without steroid injection to see the length and degree of stenosis.
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Broncoscopic dilation with stent. |
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Brncoscopic laser surgery with or without stent. |
Open Expansion Surgery:
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Laryngotracheoplasty |
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Augmentation |
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Resection with end to end anastomosis |
If the length of the anastomosis part is more, then this section cannot be pulled, up because the lungs also will come up or patient has to keep the head downward for life. Therefore it is important to mobilize the
Surgical Techniques:
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Cervical approach |
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Resection of stenotic segment |
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Stent |
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Grafting |
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No immunosuppresent. |
Procurement:
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Donors 15 - 56 years |
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Negative for HIV, HBsAg, virus, Syphilis |
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Sterile techniques. |
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Keep at 570C for 20 min. |
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Keep at -700C for 48 hours. |
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Gamma irradiation at 25kGy. |
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Deep freezing at -700C for 48 hours. |
Deep freezing will be the best method for preservation of tracheal allograft as there are failure cases of irradiated homograft transplantation in rabbits
Complication: infections, subcutaneous ephysemia. Coughing after operation may result in infections. Therefore anti-cough drugs have to be prescribed after operation.
Advantageous of deep frozen irradiated trachea:
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Elasticity |
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Easy carving |
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Sterility |
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Less antigenicity |
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Availability |
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Prolonged preservation |