Tracheal Allotransplantation–Lessons Learned

Subramania Iyer; Narayana Subramaniam; Sivakumar Vidhyadharan; Krishnakumar Thankappan; Deepak Balasubramanian; Balasubramanian K. R.; Arun Nair; Kishore Purushottaman; Janarthanan Ramu; Zachariah Paul

doi:10.1055/s-0040-1716420

Indian Journal of Plastic Surgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Indian J Plast Surg 2020; 53(02): 306-308
DOI: 10.1055/s-0040-1716420

Case Report

Tracheal Allotransplantation–Lessons Learned

Autor*innen

Subramania Iyer

¹Department of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

⁴Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Narayana Subramaniam

¹Department of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Sivakumar Vidhyadharan

¹Department of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Krishnakumar Thankappan

¹Department of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Deepak Balasubramanian

¹Department of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Balasubramanian K. R.

²Department of Cardiothoracic and Vascular Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Arun Nair

³Department of Pulmonology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Kishore Purushottaman

⁴Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Janarthanan Ramu

⁴Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Zachariah Paul

⁵Department of Nephrology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Abstract

Reconstruction of long tracheal defects still proves to be a challenge. Free fasciocutaneous flaps with cartilaginous struts or an allotransplant trachea have been reported but not been widely performed. This article reports with the experience of using a tracheal allotransplant in such a defect.

A 43-year-old lady presented with adenoid cystic carcinoma involving the entire trachea from subglottic area up to the carina, leading to a life-threatening airway occlusion. After preliminary stenting, allotransplant trachea obtained from a brain-dead individual was revascularized in the forearm of the patient after mechanical decellularization to reduce the immune load and fulfil the need for immunosuppression in the background of active cancer. Subsequently, the trachea and larynx were resected. The vascularized neotrachea was transferred successfully into the neck. The patient did well initially but succumbed to a fatal hemorrhage due to innominate vein aneurysmal rupture on the 22nd day after the transplant.

The technical details of resection, fabrication of the neotrachea, its transfer, and the lessons learnt in this tracheal allotransplant are described.

Keywords

tracheal allotransplantation - composite tissue allotransplantation - revascularization

Volltext

Referenzen

References
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