Utility of decellularization in the reconstruction of large length tracheal defects. Experimental study

Abstract

Surgical resolution of tracheal lesions (length over 7 cm), is a mandatory challenge to alleviate respiratory failure in patients who are not candidates for a tracheal resection. Decellularization allows obtaining antigens free extracellular matrix scaffolds. We evaluated the usefulness of decellularized tracheal allografts as an alternative in the repair of tracheal defects using a pig experimental model. Methods: Forty five pigs were operated on: (15 trachea donors and 30 receptors of decellularized tracheal allografts). The first phase of the project included two study groups in which the tracheal segments (donors) were decellularized by 15 cycles with sodium deoxycholate and deoxyribonuclease. One group, the allografts were reinforced with steel wire. In the second phase (three study groups), decellularization was reduced to 7 cycles supplemented; One group we performed cryopreservation and another one we used glutaraldehyde. A 10 rings tracheal decellularized segment was implanted after a tracheal resection of the same size (5 study groups of n=6 pigs/group). Results: Both decellularization techniques caused total loss of epithelium, separation of collagen fibers and alterations in staining. All tracheal receptors (5 study groups) underwent euthanasia before the second post-implant week due to severe dyspnea and tracheal stenosis, necrosis, edema, inflammation, hemorrhage and granulation tissue formation. Conclusion: Decellularization caused stenosis and tracheomalacia, regardless of whether the allografts were cryopreserved, treated with glutaraldehyde or reinforced with steel wire.