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A Promising Approach to Enhance Regeneration in Tracheal Graft

by Linda Kossoff •

Can a prevascularized segmental tracheal substitute using platysma enhance tracheal mucosal regeneration in a transplanted tracheal graft?

BOTTOM LINE

A two-step method using the platysma as an in vivo bioreactor may be a promising approach to achieve long-term survival and enhanced luminal patency of a transplanted tracheal graft.

BACKGROUND: The survival of a transplanted tracheal graft relies on sufficient vascularization. Without it, transport of progenitor cells, nutrients, and oxygen to the area is limited, resulting in delayed mucosal regeneration, inflammation, and restenosis. Researchers continue testing methodologies to accelerate neovascularization and overcome this major obstacle.

STUDY DESIGN: Animal study.

SETTING: Department of Otorhinolaryngology–Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.

SYNOPSIS: Researchers assigned 18 white rabbits (male) to one of two groups: polycaprolactone (PCL) scaffold without Matrigel coating (S), or PCL scaffold with Matrigel coating (M). The animals underwent surgery in which bilateral platysma muscular flaps were elevated and scaffolds were implanted bilaterally in the platysma. One or two weeks later, tracheal defects were created and vascularized scaffolds with feeders of the platysma were transplanted as rotational flaps. Scaffolds with or without Matrigel coating were transplanted into a tracheal defect with prevascularization. Animals with two weeks of prevascularization showed longer survival than animals with zero or one week of prevascularization, regardless of the coating. Wider airway patency was observed in group M than in group S. Group M showed migration of epithelium over the scaffold from four weeks after transplantation and complete coverage at 12 weeks; group S showed migration from 14 weeks and incomplete coverage even at 24 weeks. Researchers concluded that utilizing the platysma as an in vivo bioreactor may be a promising approach to achieve long-term survival and enhanced liminal patency, and that Matrigel coating on the scaffold had a synergistic effect on epithelial regeneration.

CITATION: Lee M, Choi JS, Eom MR, et al. Prevascularized tracheal scaffolds using the platysma flap for enhanced tracheal regeneration. Laryngoscope. 2021;131:1732-1740.