Tracheal reconstruction using a free jejunal flap with cartilage skeleton: Experimental study

An experimental study was undertaken to evaluate the behavior of an autologous microvascular jejunal transfer with a cartilage skeleton for major tracheal reconstruction in the goat model. A 15-cm segment of the cervical trachea was replaced by a free microvascular jejunal transfer with costal cartilage skeleton as a single-stage procedure. The flap was stented for 4 weeks with an endotracheal T-tube. Bronchoscopy was done to the survivors at 6 months. The perioperative mortality rate was 40 percent, with 30 percent of the animals surviving the 30-week follow-up period. Bronchoscopy showed a smooth and appropriate lumen. Histology showed hyaline cartilage integrated within the jejunal wall and normal jejunal mucosa. The reconstruction of a large circumferential tracheal defect with a free jejunal transfer with cartilaginous skeleton remained stable, without undue mucous secretion, and the surviving animals remained asymptomatic for the follow-up.