Morphological Demonstration of the Role of Implantable Bioscaffold in Airway Reconstruction Utilizing an Animal Model
Anthony Sheyn, James Coticchia, Paul C Montgomery, Tamar A Giorgadze. Wayne State University, Detroit, MI
Background: Laryngotracheal reconstruction is a relatively common procedure to repair subglottic stenosis. Usually the stenosed section of the airway is split and a costal cartilage autograft is placed to widen the lumen. Despite of 85% success rate, this procedure has significant associated morbidity, specifically the recurrence of stenosis at the graft site due to fibrosis. We propose that a recently developed cellular Bioscaffold may be useful in this procedure by stimulating native tracheal tissue growth rather than fibrous tissue, thereby decreasing the recurrence rate and reducing the necessity of harvesting autografts.
Design: Sprague Dawley rats (No 15) were were divided in 3 groups of 5: control group (G1) received no intervention; group 2 (G2) underwent incision through the cricoid and the first two tracheal rings followed by primary closure; group 3 (G3) underwent incision through the cricoid and first two tracheal rings followed by placement of 1x2 mm Bioscaffold xenograft (Acell, Columbia, MA). The animal sacrifice and tracheal specimen harvest occurred on post-operative days (POD) 1, 7, 14, 21, and 28. Specimens were routinely processed for histologic examination and stained with H&E, trichrome and PAS. The degree of following parameters was assessed: 1)airway lumen stenosis; 2)scar tissue formation; 3)inflammation; 4)Bioscaffold degradation; 5)fibrous tissue replacement by native tissue.
Results: 12 out of 15 specimens were obtained: 4 G1, 3 G2, and 5 G3. All G3 animals survived until time of specimen harvest and appeared similar in behavior to control animals. Only 1 G2 animal survived beyond POD1. There was a significant degree of scar collagen formation and luminal stenosis in G2. In contrast, all G3 animals showed a progressive decrease in inflammation and fibrous tissue amount, with minimal fibrosis evident on POD28. Most interestingly, G3 on POD28 showed circumferential presence of both normal basement membrane and respiratory epithelium, with airway lumen diameter similar to G1, consistent with complete remodeling of native tissue.
Conclusions: While this is a pilot study, we believe that utilization of implantable Bioscaffold can potentially revolutionize laryngotracheal reconstruction by promoting regeneration of native tissue instead of scarring.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 286, Wednesday Morning