• 대한기관식도과학회지
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• 제7권2호
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• pp.128-139
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• 2001

The purpose of this study was to review the literatures of experimental tracheal reconstruction. Although there have been significant advancements in the surgical treatment of the long circumferential tracheal injuries, there still has been a difficult problem with high morbidity and mortality. The method for tracheal reconstruction after circumferential resection is preferred end-to-end anastomosis for defects up to 6 cm in length, but larger tracheal defects require the use of tracheal allograft, various artificial prosthesis or autogenous organs. The tracheal allotransplantation has been widely used as there was significantly improved the method of surgical technique, preservation and immunosuppression. But it has been limited by a number of factors such as few donor, limited use of immunosuppressant, delayed revascularization and re-epitheliazation. Experimental studies on the tracheal prosthesis have a long history and they tried to use silicone, polytetrafluoroethylene, polypropylene mesh, Dacron, Marlex mesh, external or internal stents. Other experimental studies were reported the use of autogenous tissues that were cartilage. jejunum, aorta, skin, muscle, periostium or esophagus. But a great variety of these protheses have been resulted unsatisfactory in a significant Proportion of cases. Alternatively, the tissue-engineering technique has showed a new approach to reconstruct trachea and much progress in tissue-engineering bas been made recently. In conclusion, although the tracheal allotransplantation and the use of prosthesis and allograft have been reported a lot of limitation to overcome, we could sooner expect good result of ideal tracheal prosthesis.

• 대한기관식도과학회지
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• 제8권1호
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• pp.22-28
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• 2002

Background and Objectives : The aim of the this study is to determine the efficacy of an external prosthesis made of ringed Polytetrafluoroethylene to prevent Postanastomotic stenosis after surgical correction of extensive tracheal defects in rabbits. Materials and Methods : Thirty rabbits were used, divided into two groups of 15 animals each. Group A rabbits underwent resection of six-ring segments of the cervical trachea and tracheal end-to-end anastomosis. The Procedure used in group B was similar to that used in group A. but the tracheal anastomosis was supported by an external ringed polytetrafluoroethylene prosthesis. After six months, rabbits were killed and tracheas were resected and then compared the postanastomotic tracheal stenosis using morphometry. Results : Anteroposterior diameter, transverse diameter, cross sectional area and intra luminal perimeter of trachea was greater in group B than group A. Also inflammatory changes of mucosa and submucosa were greater in group A than group B. Conclusion : A ringed PTFE as a external stent was effective to prevent tracheal stenosis resulting from the extensive tracheal resection and tracheal reconstruction in rabbits.

• Journal of Chest Surgery
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• 제33권4호
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• pp.320-323
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• 2000

This case describes a tracheal stenosis complicated by endobronchial truberculosis. A 50-year-old female with progressive dyspnea was referred to us for the management of long segmental tracheal stenosis. Treatment modalities for tracheal stenosis include open surgical resectin and reconstruction, mechanical dilation, laser resection, and placement of an airway prosthesis. The following is a report of a successful treatment of a long segmental tracheal stenosis through a tracheal augmentation and the use of al Bovine pericardium. This technique may provide a relief from tracheal stenosis.

• Journal of Chest Surgery
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• 제54권3호
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• pp.191-199
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• 2021

Background: Tracheal replacement is a challenge for thoracic surgeons due to stenosis in the trachea-prosthesis anastomosis. We propose that stenosis occurs due to fibrosis as a result of an abnormal healing process, characterized by an increased expression of wound healing growth factors (vascular endothelial growth factor [VEGF], survivin, and CD31), which promote angiogenesis and decrease apoptosis. We analyzed the immunoreactivity of VEGF, survivin, CD31, and caspase-3 in the development of fibrotic stenosis in prosthetic tracheal replacement. Methods: Fourteen dogs were operated on: group I (n=7) received a 6-ring cervical tracheal segment autograft, while in group II (n=7), a 6-ring segment of the cervical trachea was resected and tracheal continuity was restored with a Dacron prosthesis. The follow-up was 3 months. Immunoreactivity studies for VEGF, survivin, CD31, and caspase-3 were performed. A statistical analysis was done using the Wilcoxon signed rank test. Results: Four animals in group I were euthanized on the 10th postoperative day due to autograft necrosis. Three animals completed the study without anastomotic stenosis. Moderate expression of VEGF (p=0.038), survivin (p=0.038), and CD31 (p=0.038) was found. All group II animals developed stenosis in the trachea-prosthesis anastomotic sites. Microscopy showed abundant collagen and neovascularization vessels. Statistically significant immunoreactive expression of VEGF (p=0.015), survivin (p=0.017), and CD31 (p=0.011) was observed. No expression of caspase-3 was found. Conclusion: We found a strong correlation between fibrosis in trachea-prosthesis anastomoses and excessive angiogenesis, moderate to intense VEGF, CD31, and survivin expression, and null apoptotic activity. These factors led to uncontrolled collagen production.

• 대한수의학회지
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• 제44권1호
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• pp.137-141
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• 2004

The purpose of this study was to compare easiness of application of polypropylene external total ring prosthesis (PPTRP, Group A) with that of polyvinylchloride external total ring prosthesis (PVCTRP, Group B), which were used for surgical correction of tracheal collapse in dogs. PPTRP was made from 3 ml syringe and PVCTRP from the drip chamber of intravenous administration set. Prostheses of group A (n=5) and B (n=5) were placed to cervical trachea in clinically normal 10 dogs, respectively weighing between 4 kg and 6 kg. There were mild coughing and swelling in one to three dogs of both groups for 3 days after surgery. No exercise intolerance was observed in both groups after surgery. There were no different results of clinical signs and radiographic views after surgery between group A and group B. The time (mean${\pm}$SD) to make total ring prosthesis, group A took $23.2{\pm}1.9$ minutes which was remarkably longer than that $(4.6{\pm}0.3)$ of group B. Also, the time to place around trachea, group A required $61.8{\pm}8.8$ minutes and group B $38.4{\pm}8.0$ minutes. Conclusionly, PVCTRP was timesaving and easier to make, fix, and suture than those of PPTRP. PVCTRP may be used alternatively to PPTRP for the tracheal collapse to treat in dogs.

• Journal of Chest Surgery
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• 제30권8호
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• pp.739-746
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• 1997

기관결손을 대체할 이장적인 보철물을 개발하려는 다양한 실험연구가 있었다. 인공기관보철물의 조건으로 는 공기에 비투과성, 적이지 않는 형태의 안전성, 생체내에서 섬 유아세포의 증식과 상피세포 재생에 필요한 생체적합성이 요구된다. 생체적합성이 우수한 포리우레탄 소재의 다공성포리우레탄 튜브에 gelatin으로 도포하고 isoplastic고리를 보강하여 외경 20 m길이 30 m의 인공기관보철물을 제작하였다. 인공기관의 생체적합성과 상피세포재생을 촉진하기위해 콜라겐 물질인 gelatin을 감마선으로 고정하여 도포하였다. 인공기관보철물을 잡종성견 10마리를 대상으로 경흉부기관에 이식하였다. 실험군에서는 다공성 폴리머에 gelatin으로 피복한 인공기관을 이식하였고 대조군에서는 gelatin으로 피복하지않은 인공기관과 ,다공성 폴리머에 gelatin을 피복한 기관에 자가심장 편을 접합시킨 것을 이식하여 실험하였다. 다공성 폴리머에 gelatin피복한 기관과 자가심낭편을 접합한 기관 을 이식한 후 6주째에 인공기관 내면에 상피화가 관찰되었다. gelatin 피복한 기관을 대상으로 외번문합과 내 문합을 비교한 결과 외번문합에서 문합부의 육아종 협착이 더 심하게 생겼다. 심낭편을 접착한 기관에서는 문합부와 접착부에 감염과 염증이 있었다. 본 실험결과 다공성포리우레탄 튜브에 gelatin을 도포한 인공기관 보철물은 상피재생과 생체적합성이 우수하며 재질개선과 문합부의 협착을 막는 연구보완이 되면 임상적용 을 기대 할수 있다.

• 대한음성언어의학회:학술대회논문집
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• 대한음성언어학회 2017년도 제46차 춘계학술대회
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• pp.2-3
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• 2017

• Journal of Chest Surgery
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• 제10권1호
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• pp.7-17
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• 1977

The increasing frequency of post-tracheostomy stenosis parallels the increase in the incidence of tracheostomy. The development of stenosis of trachea following the operation of tracheal tumor or tracheostomy is a very serious complication. The continuing need for an adequate tracheal substitute has not been answered, despite the necessities of excision and reconstruction of the trachea to keep for effective ventilation. Experimental tracheal reconstuction, with a prosthesis of heavy Marlex mesh and pericardium, _ vas performed in twelve dogs. Five to six tracheal ring circumferential defects were created and were bridged with heavy Marlex mesh fashioned into a tube of suitable diameter. Group A: A prepared cylinder of Marlex mesh was anastomosed outside the cut ends of the trachea. Group B: The external surface of the prepared cylinder of Marlex mesh was completely covered with suitably sized patch of pericardium and overlapped all margin of the Marlex mesh by 2 to 3 mm in each direction. Group C: The internal surface of the prepared cylinder of Marlex mesh was covered with suitably sized patch of pericardium and overlapped all margin of the Marlex mesh by 2 to 3 mm in each direction. The results of this exepriment were as follow: 1. In group A and B, the graft was well bridged with new granulation and fibrous tissue, and the lumen of trachea kept good patency for effective ventilation.. The interstices of Marlex became uniformly infiltrated with young well vasculated connective tissue. Epithelization has not yet occurred at 4 weeks in each group, but there were evidences of new growing mucosa at grafted site in 6 weeks. The remainder of the prosthesis was completely covered with glistening epithelium and the underlying fibrous tissue became more matured with little inflammation. These findings were more striking in group B than group A. 2. In group C, the covered pericardium was necrotized with stenosis of the lumen of grafted site due to poor blood supply.

• Journal of Chest Surgery
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• 제10권1호
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• pp.17-24
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• 1977

The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tube has produced, apparently with increasing frequency, three lesions which have serious ceminical manifestations such as tracheal stenosis, tracheomalasia, and localized tracheal erosion. Extensive resection and reconstruction of the trachea must be necessary because conservative treatment has generally failed in the fully developed stenotic lesion. of the mediastinal trachea following extensive resection is best accomplished by direct anastomosis of the patient`s own tracheobronchial tissue. Any replacement of the mediastinal trachea must be air tight and laterally rigid, and must heal dependably. A variety of materials has been used for substitution following circumferential excision of tracheal segments within the mediastinum. These attempts have often failed because of early leak or late stenosis. We have successfully performed circumferential resection and primary end-to-end anastomosis of the trachea for 4 cases of post-intubation tracheal stenosis located a few centimeter below the tracheostomy stoma in the period of 3 years between 1974 and 1976. The lesion in one patient was found in the upper trachea which was approached anteriorly through a cervicomediastinal incision with division of the upper sternum. Other three located in the lower half of the trachea were operated through a high transthoracic incision with appropriate hilar mobilization in addition to cervical flexion for the development of the cervical trachea into the mediastinum. There were no hospital death, but suture line granulations occurred in two patients were managed by bronchoscopic removal of granulations without difficulties.

• Journal of Chest Surgery
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• 제15권2호
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• pp.139-147
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• 1982

In case of segmental injury of trachea, the primary repair is very difficult, because the trachea is fixed in place without movability from the surrounding tissue. In addition to special anatomical situation of trachea, any ideal artificial prosthesis for tracheal replacement is not still appeared. Many authors proposed several procedures for the tracheal repair, but satisfactory results were few. Among the proposed procedures end to end anastomosis of trachea was noted superior when both ends of trachea could be approximated by mobilization of upper and lower injured trachea. The author's experiment was designed to determine the effect about decreased tension on trachea when the hyoid bone was released downward from the surrounding muscular structures. The experimental dogs were divided into two groups, suprahyoid releasing group (SH R) and control group of intact hyoid. SH R group was subdivided into two groups accord ing to he degree of tension. The experimental results were as follow; 1. SH R group: In view of X-ray, the distance between the angle of mandible and the displaced hyoid bone was lengthened downward. And it's range was from 1.3cm (38%) minimally to 2.7cm(108%) maximally. 2. Control group: The distance between the angle of mandible and hyoid was same in both pre and postoperation. As the result of this experiment study, the suprahyoid release technique seems to be the efficient method that enable of release the trachea maximally. And it should be expected that the SH R technique is applicable clinically.