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Purpose: To investigate the feasibility of using a new tracheal prosthesis made of biomaterials to replace extensive circumferential tracheal defects.Description: Three types of tracheal prostheses were developed and studied. Type I prosthesis was used in 8 mongrel dogs (group A), type II in 4 dogs (group B), and type III in 4 dogs (group C).Evaluation: In group A, one died from prosthetic dehiscence, another from anastomotic leakage, and the others had uneventful postoperative courses. The implanted prosthesis was completely incorporated with the recipient trachea, where different lengths of reepithelialization occurred on the luminal surface of the reconstructed trachea. Macroscopic examination showed scattered and different sizes of neo-ossification surrounding the implanted prosthesis. The prosthesis was radioopaque when exposed to routine x rays. In contrast, a relatively high number of complications occurred postoperatively in groups B and C.Conclusions: Type I tracheal prosthesis, with further improvements, may be the optimal tracheal graft to replace circumferential tracheal defects, and appears very promising for clinical application. [Copyright &y& Elsevier]

Abstract: Extensive chest wall defect reconstruction remains a challenging problem for surgeons. In the past several years, little progress has been made in this area. In this study, a biodegradable polydioxanone (PDO) mesh and demineralized bone matrix (DBM) seeded with osteogenically induced bone marrow stromal cells (BMSCs) were used to reconstruct a 6cm×5.5cm chest wall defect. Four experimental groups were evaluated (n =6 per group): polydioxanone (PDO) mesh/DBMs/BMSCs group, polydioxanone (PDO) mesh/DBMs group, polydioxanone (PDO) mesh group, and a blank group (no materials) in a canine model. All the animals survived except those in the blank group. In all groups receiving biomaterial implants, the polydioxanone (PDO) mesh completely degraded at 24 weeks and was replaced by fibrous tissue with thickness close to that of the normal intercostal tissue (P >0.05). In the polydioxanone (PDO) mesh/DBMs/BMSCs group, new bone formation and bone-union were observed by radiographic and histological examination. More importantly, the reconstructed rib could maintain its original radian and achieve satisfactory biomechanics close to normal ribs in terms of bending stress (P >0.05). However, in the other two groups, fibrous tissue was observed in the defect and junctions, and the reconstructed ribs were easily distorted under an outer force. Based on these results, a surgical approach utilizing biodegradable polydioxanone (PDO) mesh in combination with DBMs and BMSCs could repair the chest wall defect not only in function but also in structure. [Copyright &y& Elsevier]