Development of New Tracheal Prosthesis: Autogenous Mucosa-Lined Prosthesis Made from Polypropylene Mesh

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Abstract
Reliable tracheal or tissue graft has not been developed yet for the reconstruction of large, circumferential tracheal defects. Major limitations were anastomotic dehishence and stenosis, which were attributed to the poor epithelinisation of the prosthetic graft. We developed a new tracheal prosthesis that has a viable lined and well-vasculised mucosa. The prosthesis consists of Prolene® mesh reinforced with polypropylene rings, and is coated with gelatin. In addition, we lined the luminal surface of the prosthesis with transplanted autogenous oral mucosa and wrapped the prosthesis with greater omentum. Animal experiments were performed using 10 adult mongrel dogs. The transplanted mucosa and wrapped greater omentum tightly adhered to the prosthesis to make a single unit within two weeks. The mucosa survived well, was well vasculised by new vessels from greater omentum and showed normal histology. Complete surgical resection and replacement of a thoracic trachea (3 cm in length, 6 tracheal rings) were carried out in 2 dogs, which survived well with normal activity. We concluded that this highly biocompatible tracheal prosthesis could be very useful for step-wise reconstruction of tracheal defects.