Tracheal Reconstruction, When Surgery Meets Bioengineering

Tracheal replacement has been and still remains a surgical challenge. Today, partial resection, up to half of tracheal length, is a well-codified surgery and can be repaired by mobilization of the remaining tracheal stumps and direct suture. However, despite numerous proposed solutions, no valid technic have been described to allow the replacement of more than 1/2 of the trachea.

Recently, several breakthroughs have brought new hopes and may help us to consider that a definitive solution is at hand. Three main solutions drive a special attention because of their promising character. The first one, presented by Deleare and al, uses a tracheal allograph. The second relies on a complete bioengineered decellularized, recellularized trachea. Finally, our team proposed an autologous solution based on a buttressed forearm free flap.

Despite the hope brought by these advances, none is ideal and matches all 5 Grillo's requirements. Our solution fulfills 3 of them but fails to bring a ciliary epithelium, and lack reproducibility. We started a program of research, which goal is to correct these 2 weaknesses through the use of bioengineering and to obtain a chimeric construct combining autologous tissues with bioengineered ciliary epithelium and cartilage rings. We considerer this solution as an intermediary but obligatory step before a complete bioengineered trachea can be created.