Tracheal Substitutes Innovative SolutionsAhmed Anwar Abouarab
AbstractIn this review, the different methods of tracheal reconstruction were addressed. Each method has its own advatages for application, however, none were free from limitations. Various attempts to overcome these limitations has been discussed as well. To sum up, primary resection anatsomosis techniques has been modified extensively, allowing for reconstruction of larger tracheal defects. They remain the treatment of choice for tracheal reconstruction. Nevertheless, they are still limited to certain length. On the other hand, tracheal prosthesis and stents were associated with many complications when used for definitive reconstruction of the trachea. Despite that, they were indespinsable to support the trachea, while other definitive methods were being implemented. Thus, the best utilization for them, so far, is probably as temporary adjunct with another more permanent treatment. Autolgous-tissue reconstruction of the trachea has been a successful method for reconstruction when applied experimentally. In addition, this method enhanced the revascularization process when used in combination with other methods of reconstruction. In spite of this, this method is not always practical for clinical application, especially in an emergency setting. This is mainly related to the bioavailability of tissues, and perhaps the use of flaps is a more feasiable option. Noteworthy, allogenic-tissue reconstruction of the trachea showed excellent results both experimentally and clinically. The previous problem of immunogenicity and rejection has been grealty addressed and surpassed by different methods. Interestingly, the need for immunosuppressive therapy has been eliminated, making this method one of the most promising methods for reconsruction of long segments of tracheal defects with unlimited supply of tissues. Additionally, combining this method with other methods of reconstruction has been associated with even better results. Finally, tissue-engineered tracheas used for reconstruction have shown promising results similar to that of allogenic-tissue repair. After many successful experimental methods, clinical application as last resort of treatment was associated with good results. This method holds the future for long segment tracheal defects repair. However, these results still need to be solidified by furthur research, particularly, in clinical application and minimizing the costs and time of preparation. In the end, combining the different mtheods of reconstruction showed superior outcomes to using any of them soley giving hope of cure to those patients with long tracheal defects. Nonetheless, a stepwise management of tracheal defects is fundamental to achieve the best results based on individualized varibales.
|Other Titles||حلول ابداعية لبدائل القصبة الهوائية||Issue Date||2017||URI||http://research.asu.edu.eg/handle/12345678/2564|
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