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Laryngotracheal reconstruction with porous titanium in rabbits: are vascular carriers and mucosal grafts really necessary?

Authors

  • Luuk M. Janssen,

    1. Department of Otorhinolaryngology, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
    Current affiliation:
    1. Department of Otorhinolaryngology, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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  • Gerjo J. V. M. van Osch,

    1. Department of Otorhinolaryngology, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
    2. Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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  • Jia Ping Li,

    1. Institute for Biomedical Technology, Twente University, Prof. Bronkhorstlaan 10-D, 3723 MB Bilthoven, The Netherlands
    2. PoroGen B.V. Enschede, The Netherlands
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  • Nicole Kops,

    1. Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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  • Klaas de Groot,

    1. Institute for Biomedical Technology, Twente University, Prof. Bronkhorstlaan 10-D, 3723 MB Bilthoven, The Netherlands
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  • Louw Feenstra,

    1. Department of Otorhinolaryngology, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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  • José A. U. Hardillo

    Corresponding author
    1. Department of Otorhinolaryngology, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
    • Department of Otorhinolaryngology, Erasmus MC, University Medical Centre Rotterdam, Room HS 601, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Abstract

Laryngotracheal reconstruction requires a supportive structure with a mucosal lining, which needs a vascular supply in order to regenerate properly. We investigated the necessity of a vascular carrier and mucosal graft when using porous titanium for laryngotracheal reconstruction. Surgical defects of the laryngotracheal complex in 22 rabbits were reconstructed with: (a) porous titanium implanted on a vascularized fascia combined with a buccal mucosal graft (first stage) before transposing to the neck area (second stage); (b) porous titanium implanted on a vascularized fascia (first stage) combined with a mucosal graft (second stage); (c) porous titanium on a pedicled fascia flap; and (d) porous titanium alone. The grafts were tolerated well. Re-epithelialization occurred in all groups. Normal mucosa with a submucosal layer containing vital cells was noted using the titanium implants. Blood vessels were grown in the pores of the titanium scaffold to supply the overlying mucosa. The scaffold was well integrated in the adjacent tracheal cartilage and surrounding tissues, except in the two cases that showed titanium displacement. Inflammation and granulation formation were seen in most rabbits in groups III and IV, initiated probably by the use of buccal mucosal grafts. Reconstruction of a rabbit's trachea using composites of porous titanium, mucosal grafts and a fascia flap is feasible. Titanium seems to meet the requirements needed for closing a small defect of the tracheal wall and allows for re-epithelialization. For larger defects, a vascular carrier with a mucosal graft is probably indispensable to ensure the process of re-epithelialization. Copyright © 2010 John Wiley & Sons, Ltd.

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