Comparison of costal cartilage and Dacron® graft in laryngotracheal reconstruction: an experimental study

Abstract

Objective: To evaluate the use of the Dacron® implant in laryngeal reconstruction and to discuss potential indications of this material in head and neck surgeries. Methods: Three groups consisting of 12 Wistar albino rats in each were formed, Group 1 was the control group and anterior laryngotratecheal reconstruction was performed by transplanting autologous costal cartilage sized 5¥5¥5 mm obtained by 6 mm longitunal sectioning extending from cricoid cartilage to the 5th tracheal ring. Group 2: Trachea sectioning was performed in equal lengths as in Group 1, and anterior laryngotracheal reconstruction was carried out by transplanting the same sized homologous cartilage. Group 3: Trachea sectioning was performed in equal lengths as in Group 1 and anterior laryngotracheal reconstruction was carried out by Dacron® graft in the same size. The rats were sacrificed in the 12th week of the implantation, and the groups were compared in terms of their tracheal section area, partial oxygen pressure, epithelialization, neovascularization, inflammatory cell infiltration and new chondrocyte development. Results: One experimental animal in Group 1 was lost due to pneumothorax on the second day postoperatively. In Group 3, one animal died because of development of granulation and crusting on the 8th day postoperatively. There was no statistically significant difference between the groups in terms of tracheal cross sectional area, and partial oxygen pressure. While there was no significant difference in terms of epithelial development and neovascularization between Groups 2 and 3, while Group 1 was significantly better than Groups 2 and 3. Lymphocytic infiltration is an essential parameter in graft rejection and there was a significant difference between the groups. Group 1 was better than the other two groups but it was determined that Group 3 was considerably different from Group 2. There was a significant difference between Groups 1 and 2 in terms of new chondrocyte development. Conclusion: Autogenous costal cartilage is an ideal graft material for trachea and larynx since scores of epithelial development, neovascularization and chondrocyte development are better. Dacron® implant can be used safely in laryngeal reconstrucion as stenosis, infection and rejection did not occur in Group 3 exposed to Dacron®, and epithelial development and nerovascularization occurred satisfactorily in all experimental animals.

Keywords

• Laryngotracheal reconstruction, Dacron®, anterior laryngotracheal splint

Larengotrakeal rekonstrüksiyonda kosta kıkırdağıyla Dacron® greftin karşılaştırması: Deneysel çalışma

Öz

Amaç: Larenks rekonstrüksiyonunda Dacron® implant kullanımını değerlendirmek ve bu materyalin baş-boyun cerrahilerinde potansiyel endikasyonlarını tartışmak. Yöntem: Her biri 12 Wistar albino sıçandan ibaret üç grup oluşturuldu. Grup 1 kontrol grubu olup bu gruptaki sıçanlarda krikoit kıkırdaktan 5. trakea halkasına kadar 6 mm uzunluğunda kesi yapılarak elde edilen 5¥5¥5 mm'lik otolog kosta kıkırdağı transplantasyonu yoluyla anterior larengotrakeal rekonstrüksiyon gerçekleştirildi. Grup 2'de, Grup 1'de olduğu gibi trakea eşit uzunluklarda bölümlere ayrıldı ve aynı büyüklükte homolog kıkırdak nakliyle anterior larengotrakeal rekonstrüksiyon gerçekleştirildi. Grup 3'de trakea, Grup 1'e eşit bölümlere ayrıldı ve aynı büyüklükte bir Dacron® greftiyle rekonstrüksiyon yapıldı. İmplantasyondan sonraki 12. haftada sıçanlar sakrifiye edildi ve hasta gruplar trakea kesit alanı, parsiyel oksijen basıncı, epitelizasyon, neovaskülarizasyon, enflamatuar hücre infiltrasyonu ve yeni kondrosit oluşumu açısından karşılaştırıldı. Bulgular: Grup 1'de postoperatif 2. günde pnömotoraks ve Grup 3'de ise 8. günde granülasyon ve krutlanma nedeniyle birer deney hayvanı kaybedildi. Trakea enine kesit alanı ve parsiyel oksijen basıncı açısından gruplar arasında herhangi bir istatistiksel farklılık yoktu. Grup 2 ve Grup 3 arasında epitel gelişimi ve neovaskülarizasyon açısından istatistiksel bir farklılık yoktu ancak Grup 1, diğer iki gruptan anlamlı derecede daha iyi idi. Greft reddinde lenfosit infiltrasyonu önemli bir parametre olup gruplar arasında önemli bir farklılık vardı. Grup 1, diğer 2 gruptan daha iyi olduğu gibi Grup 3'ün, Grup 2'den hatırı sayılır derecede farklı olduğu belirlendi. Yeni kondrosit gelişimi açısından Grup 1. ile Grup 2 arasında anlamlı bir farklılık vardı. Sonuç: Epitel, neovaskülarizasyon ve kondrosit gelişim skorları daha iyi olduğu için otojen kosta kıkırdağı trakea ve larenks için ideal greft materyalidir. Dacron®'un kullanıldığı grupta stenoz, enfeksiyon ve rejeksiyon olmadığı, tüm deney hayvanlarında epitel gelişimi ve neovaskülarizasyon tatminkâr derecede oluştuğu için larenks rekonstrüksiyonunda Dacron® implantları güvenle kullanılabilmektedir.

Anahtar Kelimeler

• Larengotrakeal rekonstrüksiyon, Dacron®, anterior larengotrakeal splint

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