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Ann Thorac Surg 2004;77:405
© 2004 The Society of Thoracic Surgeons

Invited commentary

Mayo Clinic Jacksonville, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

e-mail: odell.john@mayo.edu

The first 20% of the full text of this article appears below.

Fortunately, in any thoracic surgical practice the need for more extensive tracheal procedures is uncommon. Lengthy tracheal lesions that cannot be safely reconstructed are usually managed by irradiation and patency is preserved by T-tubes or stents. An excellent review of the requirements for tracheal replacement has been provided by Grillo [1]. These requirements, iterated by Grillo, appear almost unattainable and are listed below:

Requirements for Tracheal Substitution: Lateral rigidity Airtightness Integration into adjacent tissue No immunosuppressive therapy Biocompatible Nontoxic Nonimmunologic Noncarcinogenic No dislocation No erosion Should provide or facilitate epithelialization No buckling Stenosis should not develop Resist bacterial colonization Avoid accumulation of secretions Must be permanent

The quest for a tracheal replacement has continued over years. Many isolated, small experimental or case reports have been described. The technique of lateral tracheal excision with patching, even with autogenous material, frequently failed because of tumor recurrence due to inadequate margins accepted because structural stability was the prominent consideration. The airway is never sterile and foreign materials, even porous, allowing tissue ingrowth . . . [Full Text of this Article]

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