Tracheal Allotransplantation–Lessons Learned
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...
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| Format: | Article |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2020-08-01
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| Series: | Indian Journal of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1716420 |
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| author | Subramania Iyer Narayana Subramaniam Sivakumar Vidhyadharan Krishnakumar Thankappan Deepak Balasubramanian Balasubramanian K. R. Arun Nair Kishore Purushottaman Janarthanan Ramu Zachariah Paul |
| author_facet | Subramania Iyer Narayana Subramaniam Sivakumar Vidhyadharan Krishnakumar Thankappan Deepak Balasubramanian Balasubramanian K. R. Arun Nair Kishore Purushottaman Janarthanan Ramu Zachariah Paul |
| author_sort | Subramania Iyer |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-a3da47ad6c4347d2be448e5527fa84e2 |
| institution | Kabale University |
| issn | 0970-0358 1998-376X |
| language | English |
| publishDate | 2020-08-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Plastic Surgery |
| spelling | doaj-art-a3da47ad6c4347d2be448e5527fa84e22025-08-20T03:38:25ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Plastic Surgery0970-03581998-376X2020-08-01530230630810.1055/s-0040-1716420Tracheal Allotransplantation–Lessons LearnedSubramania Iyer0Narayana Subramaniam1Sivakumar Vidhyadharan2Krishnakumar Thankappan3Deepak Balasubramanian4Balasubramanian K. R.5Arun Nair6Kishore Purushottaman7Janarthanan Ramu8Zachariah Paul9Department of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Head and Neck Oncology and Plastic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Cardiothoracic and Vascular Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Pulmonology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaDepartment of Nephrology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, IndiaReconstruction 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1716420tracheal allotransplantationcomposite tissue allotransplantationrevascularization |
| spellingShingle | Subramania Iyer Narayana Subramaniam Sivakumar Vidhyadharan Krishnakumar Thankappan Deepak Balasubramanian Balasubramanian K. R. Arun Nair Kishore Purushottaman Janarthanan Ramu Zachariah Paul Tracheal Allotransplantation–Lessons Learned Indian Journal of Plastic Surgery tracheal allotransplantation composite tissue allotransplantation revascularization |
| title | Tracheal Allotransplantation–Lessons Learned |
| title_full | Tracheal Allotransplantation–Lessons Learned |
| title_fullStr | Tracheal Allotransplantation–Lessons Learned |
| title_full_unstemmed | Tracheal Allotransplantation–Lessons Learned |
| title_short | Tracheal Allotransplantation–Lessons Learned |
| title_sort | tracheal allotransplantation lessons learned |
| topic | tracheal allotransplantation composite tissue allotransplantation revascularization |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1716420 |
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