tracheal replacement devices
TRANSCRIPT
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 1/22
Seminar by Ashmita Poddar
Roll no. 25
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 2/22
Introduction
Requirements for tracheal replacement
Various approaches
Artificial trachea
Literature survey
Conclusion/summary
References
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 3/22
TRACHEA: The Trachea or the wind pipe is a part of the respiratorysystem through which the air passes in organisms.
As the ability to reconstruct parts of the body has increased, so has
the potential for complications associated with the replacement
devices used to do so. Some of the most significant complicationsassociated with replacement devices are caused by infections at
the implantation site.
As the trachea is located facing the ´external environment,µ
these prostheses are exposed to a high risk of infections and severecomplications.
Hence developing a compatible tracheal replacement device is a
challenge ahead of the biomedical engineers.
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 4/22
Laterally rigidbut longitudinally
flexible tube
Surface ciliated
respiratoryepithelium
Requirements
for a trachealreplacement
device
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 5/22
Material used should have following properties:
1.Biocompatible
2.Non toxic
3. Non carcinogenic
4.Must not dislocate or erode over time5.Ideally should provide or facilitate epithelial
resurfacing
6.Should avoid stenosis7.Should resist bacterial colonization
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 6/22
Tissue engineering of needed components
such as cartilage
Transplantation of allografts with and
without immunosuppressive therapy,preservation, and vascularization procedures.
Trials of a host of foreign materials with
many technical modifications to avoid
complications of implantation Implantation of nonviable tissues
Reconstruction with artificial material .
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 7/22
Artificialtrachea
NONPOROUS
TYPE
MESHTYPE
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 8/22
Comprises a silicone tube with two suture rings
(Dacron)attached to each of its ends.
Used it on a total of 62 patients from 1970 to
1988.
Late complications, such as migration of the
artificial trachea and granular tissue formation
at anastomosis
Not used for patients with benign tracheal
disease.
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 9/22
Courtesy: the Biomedical Engineering Handbook by Joseph D. Bronzino (Editor-in-Chief)
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 10/22
T shaped as the name suggests
Courtesy: The Biomedical Engineering handbook by Joseph D. Bronzino(Editior-in-Chief)
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 11/22
Major advantage of such nonporous
tubular prostheses is that airway
patency can be ensured.T
herefore,for patients for whom end-to-end
anastomosis is impossible,
nonporous prostheses may be used
as the last resort to avoidthreatened suffocation
(asphyxiation).
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 12/22
Courtesy: the biomedical engineering handbook by Joseph D. Bronzino
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 13/22
Non elastic
Suture rings poses a problem when used for
long term
Problems at the anastomosis
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 14/22
1950s: Several trials of tracheal
reconstruction using metallic meshes made
of tantalum and stainless steel were
conducted . 1960s: Heavy Marlex mesh (trademark
name for high density polyethylene and
crystalline polypropylene ) was used
clinically for tracheal reconstruction, andgood short-term results were reported.
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 15/22
The optimal pore size for tracheal
replacement mesh is 200 ~ 300 m. Fine
Marlex mesh is made of polypropylene with a
pore size 200- 300 m.
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 16/22
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 17/22
air-tight
Good tissue regeneration is achieved .
The grafted collagen has excellent biocompatibility
and promotes connective tissue infiltration into the
mesh.
However, the fine mesh alone was too soft to keep
the tube open, so a tracheal prosthesis was made of
collagen-grafted fine Marlex mesh reinforced with a
continuous polypropylene spiral
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 18/22
This research was carried out by H. H.
Schauwecker*, J. Gerlach* ,H. Planck**
and E. S. Bücherl* in west Germany
(*Chirurgische Universitatsklinik undPoliklinik Klinikum Charlotte burg, Freie
Universität Berlin, West-Germany, **Institut
für Textil-und Verfahrenstechnik,
Denkendorf, F.R.G. Correspondenceto Chirurgische Klinik und Poliklinik,
Klinikum Charlotte burg, FU Berlin,
Spandauer Damm 130, D-1000 Berlin 19,
F.G.R ) in 1989.
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 19/22
Porous polyurethane (nonwoven) was used for thedevelopment of tracheal prosthesis, which-in aspecial testing design-was adapted to shape andimitate the biomechanic properties of the naturalorgan. This prosthesis was implanted into 19 beagledogs using end-to-end anastomosis. Insufficiency ofthe anastomosis or infection was observed in theend-to-end anastomosis, whereas the invertedanastomosis showed complete incorporation into
surrounding tissue of the porous prosthesis but wascomplicated by airway obstruction due toanastomosis granuloma.
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 20/22
There has been a flood of tracheal
transplantation experiments in recent years.
With the present limitations that the
biomedical engineers face, the prospects forjustifiable tracheal replacement device as a
solution for extended tracheal resection still
remains remote. Tracheal transplantation
has a long way to go and extensive researchis being carried out to find a device that
aims at increased life quality of the
patients.
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 21/22
1. A Textbook of Biology, Volume II M. Sudhakar Rao
2. Scherer M.A., Ascherl R., Geissdorfer K., et al. Experimentalbiosynthetic reconstruction of the trachea. Arch Otorhinolarynol1986;243:215-223. (Referred by Hermes C. Grillo)
3. Tracheal replacement: a critical review
Hermes C. Grillo, MD*a,b
a Division of General Thoracic Surgery, Massachusetts General Hospital,Boston, Massachusetts, USAb Department of Surgery, Harvard Medical School, Boston, Massachusetts,USA
4. Rob C.G., Bateman G.H. Reconstruction of the trachea and cervicaloesophagus. Br J Surg 1949;37:202-205. (Referred by Hermes C. Grillo)
5. Belsey R. Resection and reconstruction of the intrathoracic trachea.Br J Surg 1950;38:200- 205.[Medline] (Referred by Hermes c. Grillo).
6. The Biomedical Engineering Handbook, second edition, Volume 1, byJoseph D. Bronzino (Editor- in- chief).
7. Jackson T.L., O·Brien E.J., Tuttle W., Meyer J. The experimental use ofhomogenous tracheal transplants in the restoration of continuity of thetracheobronchial tree. J Thorac Surg 1950;20:598-612. ( Referred byHermes C. Grillo)
8/8/2019 Tracheal Replacement Devices
http://slidepdf.com/reader/full/tracheal-replacement-devices 22/22