Optimal dose of basic fibroblast growth factor for long-segment orthotopic tracheal autografts

Abstract

When a primary anastomosis of the trachea is not feasible, extensive grafting is required. However, despite the use of omental wrapping for revascularization, long-segment tracheal grafts frequently do not maintain structural integrity because of insufficient blood supply. We examined the use of basic fibroblast growth factor for preservation of long-segment tracheal autografts after orthotopic transplantation with omental wrapping in 23 dogs. All animals received orthotopic tracheal transplantation, with 14-ring autografts that occupied a major part of the thoracic trachea, and omental wrapping. The 23 animals were classified randomly into six groups as follows: no treatment (group I, n = 3), topical administration of fibrin glue alone (group II, n = 4), fibrin glue enriched with 1 μg/cm 2 basic fibroblast growth factor (group III, n = 4), fibrin glue enriched with 5 μg/cm 2 basic fibroblast growth factor (group IV, n = 4), and fibrin glue enriched with 10 μg/cm 2 basic fibroblast growth factor (groups V and VI, each n = 4). The omentum that was used to wrap the autografts was fed by the right gastroepiploic artery in groups I to V and by both the right gastroepiploic artery and splenic artery in group VI. All autografts in groups I and II showed dissolution. Ten of 12 autografts in groups III, V, and VI did not maintain long-term structural integrity. By contrast, all autografts in group IV showed long-term viability, as demonstrated by graft patency, epithelialization, cartilage morphology, and vascularity. We conclude that treatment with fibrin glue enriched with 5 μg/cm 2 basic fibroblast growth factor in combination with omental wrapping may prolong the viability of long-segment tracheal autografts(J Thorac Cardiovasc Surg 1997;113:26-36)