Comparison of Xiphoid, Tyhroid and Auricular Cartilage Grafting in Tracheal Reconstruction for Histological Analysis: The Rabbit Model
Öz
Following the anterior tracheal wall resection, a histological analysis was made to compare the utility of xiphoid cartilage, thyroid ala superior cartilage and auricular cartilage as autologous graft materials with respect to tissue compatibility in tracheal reconstruction. The study included 30 male New Zealand white rabbits of 15 weeks of age. An anterior tracheal defect of approximately 1 cm2 was formed in all rabbits. The defect was repaired with xiphoid cartilage autolog grafts in a group of 10 rabbits, with thyroid ala superior cartilage autolog grafts in another group of 10 and with auricular cartilage autolog grafts in the remaining group of 10 rabbits to form 3 different study groups. Five from each group were sacrificed in the postoperative fourth and eighth weeks and the grafts applied were investigated with a histological analysis. Histological parameters for comparison included inflammation, cartilage proliferation, cartilage resorption, graft viability, epithelization, foreign body reaction in the peripheral tissues, microabcess formation and tendency for prolapsus. Among the three type of autologous graft materials, the thyroid ala superior cartilage was observed to show the lowest cartilage proliferation (p=0.032). The auricular cartilage was identified to yield the lowest graft viability and the highest cartilage resorption (p=0.015). The xiphoid cartilage was observed to have the best cartilage proliferation and graft viability (p<0.05). Although no inflammation was observed in auricular cartilage grafts, the rate of inflammation was similar in xiphoid cartilage and thyroid ala superior grafts (p>0.05). No evidence of inflammation was observed in rabbits with auricular grafting. Despite the fact that all groups showed epithelization and various degrees of foreign body reaction in the peripheral tissues, the thyroid ala superior cartilage grafting was found to have the highest degree of foreign body reaction in the peripheral tissues (p=0.016). Due to qualities of maintaining cartilage graft viability for an extended period of time and sustaining higher degrees of cartilage proliferation besides lower degrees of cartilage resorption, the xiphoid cartilage grafting was assessed to serve as a better option in the tracheal reconstruction in comparison to its thyroid ala superior and auricular cartilage counterparts.
Anahtar Kelimeler
reconstruction auricular cartilage thyroid cartilage xiphoid cartilage
Kaynakça
- 1. Kojima K, Vacanti CA, Generation of a tissue-engineered tracheal equivalent. Biotechnol Appl Biochem 2004;39:257-62.
- 2. Jong LA, Park AH, Raveh E, Schwartz MR, Forte V. Comparison thyroid, auricular, and costal cartilage donor sites for laryngotracheal reconstruction in animal model. Arch Otolaryngol Head Neck Surg 2000;126:49-53.
- 3. Brandariz JA, Grau M. Tracheal wall for the reconstruction of extended hemilaryngectomy in the rabbit model. Otolaryngol Head Neck Surg 2005;132:770-5.
- 4. Lusk RP, Kang DR, Muntz HR. Auricular cartilage grafts in laryngotracheal reconstruction. Ann Otol Rhinol Laryngol 1993;102:247-54.
- 5. Cotton RT. The problem of pediatric laryngotracheal stenosis: a clinical and experimental study on the efficacy of autogenous cartilaginous grafts placed between vertically divided halves of the posterior lamina of the cricoid cartilage. Laryngoscope 1991;101(pt2suppl 56): 1-34.
- 6. Zalzal GH, Cotton RT, McAdams JA. Cartilage grafts-present status. Head & Neck Surg 1986;8:363-74.
- 7. Keskin Gl, Oz F, Oz B, Oktem F, Gustafson M. Tracheal reconstruction using alcohol-stored homologous cartilage and autologous cartilage in the rabbit model. Int J Pediatr Otorhinolaryngol 2000:56;161-7.
- 8. Backer CL, Mavroudis C, Dunham ME, Holinger L. Intermediate-term results of the free tracheal autograft for long segment congenital tracheal stenosis. J Pediatr Surg 2000;35:813-9.
- 9. Backer CL, Mavroudis C, Dunham ME, Holinger LD. Repair of congenital tracheal stenosis with a free tracheal autograft. J Thorac Cardi-ovasc Surg 1998;115:869-74.
- 10. Dal T, Demirhan B. Reconstruction of tracheal defects with dehydrated human costal cartilage: An experimental study in rats. Otolarynygol Head Neck Surg 2000;123:607-12.
- 11. Cotton RT, Gray SD, Miller RP. Update of Cincinnati experience in pediatric larengotrac-heal reconstruction. Laryngoscope 1989:99: 1111-6.
- 12. Wiatrak BJ, Albert DM, Holmes DK, Cotton RT. Cartilage graft epithelization: a preliminary study using a goat model. Arch Otolaryngol Head Neck Surg 1993; 119:777- 816.
- 13. Zalzal GH, Cotton RT, McAdams AJ. The survival of costal cartilage graft in laryngotracheal reconstruction. Otolaryngol Head Neck Surg 1986;94:204-11.
- 14. Moutsouris C, Karayannakos P, Kairis M, Dontas I, Skalkeas G. Reversed free periosteal grafting of extensive tracheal defects in dogs. J Pediatr Surg 1989;24:570-2.
- 15. Hoff PT, Esclamado RM. Use of revascularized, tubed costal myoperiosteal graft for repair of circumferential, segmental tracheal defects. Otolaryngol Head Neck Surg 1999; 120:706-12.
- 16. Balderman SC, Weinblatt G. Tracheal autograft revascularization. J Thorac Cardiovasc Surg 1987;94:434-41.
- 17. Strome M, Norris CM, Joseph MP, Brodsky G, Ea-vey RD. An assesment of grafts in the posterior cricoid lamina. Laryngoscope 1982;92:1120-25.
- 18. Lattyak BV, Maas CS, Sykes JM. Dorsal onlay cartilage autografts: comparing resorption in a rabbit model. Arch Facial Plast Surg 2003;5:240-3.
Trakea Rekonstrüksiyonunda Ksifoid Kıkırdak, Tiroid ve Auriküla Kıkırdak Greftlerinin Histolojik Analizle Karşılaştırılması: Tavşan Modeli
Öz
Trakea ön duvar rezeksiyonunu takiben ksifoid kıkırdak, tiroid ala superior kıkırdağı ve auriküler kıkırdak otolog greft materyalleri ile yapılan rekonstrüksiyonların doku uyumu açısından histolojik analizle karşılaştırmasıdır. Araştırmada 15 haftalık 30 adet erkek Yeni Zelanda tavşanı kullanıldı. Tavşanların trakeasının anterior bölümünde yaklaşık 1 cm”lik defekt oluşturuldu. Bu defektlerin 10 tanesi ksifoid kıkırdak, 10 tanesi tiroid ala superior kıkırdağı ve geri kalan 10 tanesi ise auriküler kıkırdak otolog greftleri ile tamir edilerek üç grup oluşturuldu. Her gruptan beşer tavşan ameliyattan sonraki dördüncü ve sekizinci haftada sakrifıye edilerek, uygulanan greftlerin histolojik analizleri yapıldı. Her materyalde histolojik parametrelerden enflamasyon, kıkırdak prolife-rasyonu, kıkırdak rezorbsiyonu, greft canlılığı, epitelizasyon, çevre doku yabancı cisim reaksiyonu, mikroapse ve prolapsus gelişimi değerlendirildi. Her üç greft arasından kıkırdak proliferasyonu en az tiroid ala superior kıkırdağı greftinde olduğu gözlendi (p=0,032). Greft canlılığının en az ve kıkırdak rezorbsiyonunun ise maksimum olduğu kıkırdak grefti auriküler kıkırdak olarak saptandı (p=0,015). En iyi kıkırdak proliferasyonu ve greft canlılığının ksifoid kıkırdak otolog greftinde olduğu gözlendi (p<0,05). Enflamasyon auriküler kıkırdakta hiç yokken, ksifoid kıkırdak grefti ile tiroid ala superior kıkırdağı greftinde benzer orandaydı (p>0,05). Auriküler kıkırdak grefti uygulanan hiçbir tavşanda ise enflamasyon gözlenmedi. Tüm gruplarda epitelizasyon ve çeşitli derecelerde çevre doku yabancı cisim reaksiyonu gözlense de, tiroid ala superior kıkırdağı greftinde daha fazla çevre doku yabancı cisim reaksiyonu saptandı (p=0,016). Ksifoid kıkırdak greftinin canlılığını uzun süre koruması, kıkırdak proliferasyonunun diğer kıkırdak greftlerine göre daha fazla ve kıkırdak rezorbsiyonunun ise daha az olması gibi nedenlerle trakea rekonstrüksiyonlarında tiroid ala superior kıkırdağı ve auriküler kıkırdak greftlerine göre daha iyi bir seçenek olduğu kararına varıldı.
Anahtar Kelimeler
Trakea rekonstrüksiyon auriküler kıkırdak tiroid kıkırdak ksifoid kıkırdak
Kaynakça
- 1. Kojima K, Vacanti CA, Generation of a tissue-engineered tracheal equivalent. Biotechnol Appl Biochem 2004;39:257-62.
- 2. Jong LA, Park AH, Raveh E, Schwartz MR, Forte V. Comparison thyroid, auricular, and costal cartilage donor sites for laryngotracheal reconstruction in animal model. Arch Otolaryngol Head Neck Surg 2000;126:49-53.
- 3. Brandariz JA, Grau M. Tracheal wall for the reconstruction of extended hemilaryngectomy in the rabbit model. Otolaryngol Head Neck Surg 2005;132:770-5.
- 4. Lusk RP, Kang DR, Muntz HR. Auricular cartilage grafts in laryngotracheal reconstruction. Ann Otol Rhinol Laryngol 1993;102:247-54.
- 5. Cotton RT. The problem of pediatric laryngotracheal stenosis: a clinical and experimental study on the efficacy of autogenous cartilaginous grafts placed between vertically divided halves of the posterior lamina of the cricoid cartilage. Laryngoscope 1991;101(pt2suppl 56): 1-34.
- 6. Zalzal GH, Cotton RT, McAdams JA. Cartilage grafts-present status. Head & Neck Surg 1986;8:363-74.
- 7. Keskin Gl, Oz F, Oz B, Oktem F, Gustafson M. Tracheal reconstruction using alcohol-stored homologous cartilage and autologous cartilage in the rabbit model. Int J Pediatr Otorhinolaryngol 2000:56;161-7.
- 8. Backer CL, Mavroudis C, Dunham ME, Holinger L. Intermediate-term results of the free tracheal autograft for long segment congenital tracheal stenosis. J Pediatr Surg 2000;35:813-9.
- 9. Backer CL, Mavroudis C, Dunham ME, Holinger LD. Repair of congenital tracheal stenosis with a free tracheal autograft. J Thorac Cardi-ovasc Surg 1998;115:869-74.
- 10. Dal T, Demirhan B. Reconstruction of tracheal defects with dehydrated human costal cartilage: An experimental study in rats. Otolarynygol Head Neck Surg 2000;123:607-12.
- 11. Cotton RT, Gray SD, Miller RP. Update of Cincinnati experience in pediatric larengotrac-heal reconstruction. Laryngoscope 1989:99: 1111-6.
- 12. Wiatrak BJ, Albert DM, Holmes DK, Cotton RT. Cartilage graft epithelization: a preliminary study using a goat model. Arch Otolaryngol Head Neck Surg 1993; 119:777- 816.
- 13. Zalzal GH, Cotton RT, McAdams AJ. The survival of costal cartilage graft in laryngotracheal reconstruction. Otolaryngol Head Neck Surg 1986;94:204-11.
- 14. Moutsouris C, Karayannakos P, Kairis M, Dontas I, Skalkeas G. Reversed free periosteal grafting of extensive tracheal defects in dogs. J Pediatr Surg 1989;24:570-2.
- 15. Hoff PT, Esclamado RM. Use of revascularized, tubed costal myoperiosteal graft for repair of circumferential, segmental tracheal defects. Otolaryngol Head Neck Surg 1999; 120:706-12.
- 16. Balderman SC, Weinblatt G. Tracheal autograft revascularization. J Thorac Cardiovasc Surg 1987;94:434-41.
- 17. Strome M, Norris CM, Joseph MP, Brodsky G, Ea-vey RD. An assesment of grafts in the posterior cricoid lamina. Laryngoscope 1982;92:1120-25.
- 18. Lattyak BV, Maas CS, Sykes JM. Dorsal onlay cartilage autografts: comparing resorption in a rabbit model. Arch Facial Plast Surg 2003;5:240-3.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Göğüs Cerrahisi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 27 Temmuz 2008 |
| Yayımlandığı Sayı | Yıl 2008 Cilt: 2 Sayı: 2 |
