Effect of Omentum, Pleura, Diaphragm on Tracheal Autograft Survival

Keum, Dong Yoon

Abstract

BACKGROUND: Pleura, diaphragm, pericardial fat pad, intercostal muscles and omentum can be used to protect and revascularize the bronchial suture line of tracheal transplantation, lung transplantation and pulmonary resection. The purpose of the present study is to compare the influence of the pleura, diaphragm and omentum in survival of isolated tracheal segments in the experimental animals. MATERIAL AND METHOD: Sprague-Dawley rats weighing 250~350 g were used. The animals were divided in three groups; the pleura, omentum and diaphragm. Following intraperitoneal anesthesia, endotracheal intubation was performed. Then the trachea was exposed. A three-ring section of cervical trachea was excised. The resected trachea was implanted at each sites. After 2 weeks, rats were sacrificed. Histopathological examination of the tracheal segments was performed. For comparison of each groups, histopathological viability of resected tracheal segment was scored by three tissue layers; epithelium, submucosa, and cartilage. The results were presented as average score. RESULT: In histopathological examination, submucosa and cartilage using tracheal segment necrosis scoring system. The pleural group showed well preserved tissue. There was minimal necrosis and inflammation compared with other groups. In the pleural group, tracheal necrosis scores were 2.17+/-0.983 at epithelium, 1.67+/-0.516 at submucosa and 2.17+/-0.753 at cartilage. At the omental group, scores were 1.00+/-0.00, 1.60+/-0.548 and 1.80+/-0.447. In the diaphragmatic group, scores were 1.40+/-0.894, 2.40+/-0.547 and 2.20+/-0.447. Total necrosis score were 6.00+/-1.789 in the pleural group, 4.40+/-0.894 in the omental group and 6.00+/-1.414 in the diaphragmatic group.
CONCLUSION
There were no significant viability differences in terms of total necrosis score for the viability of resected tracheal segment. But the best result was achieved in the omental group. Therefore, omental wrapping on tracheal graft site will be beneficial for the prevention of graft necrosis.