Improvement of tracheal autograft survival with transplantation into the greater omentum

Reconstruction of tracheal defects with tracheal grafts is not practicable clinically because the problem of tracheal graft revascularization has not been solved successfully. We conducted experiments to investigate efficacy of implanting tracheal graft into the greater omentum for revascularization and possibility of adopting staged transplantation procedure for repair of tracheal defect. Twenty-four mongrel dogs were randomly and equally divided into groups I and II. Six-ring cervical tracheal segments were harvested as autografts. The grafts were wrapped with the omentum and placed into the peritoneal cavity in group I, and reimplanted with omentopexy in group II. Four grafts were examined macroscopically, microscopically, and 35S-autoradiographically on postoperative days 3, 7, and 14, respectively. Epithelium loss was evident in the mucosas of the grafts except the 4 from group I. Percentages of viable chondrocytes assessed with 35S-autoradiography were significantly higher in tracheal grafts from group I than group II. All tracheal grafts with their own omental pedicles could be brought to any portions of the trachea. We conclude that prior implantation of tracheal graft in the omentum is beneficial for preservation of its structure, and reconstruction of a tracheal defect with a tracheal graft implanted first into the omentum is feasible.