Experimental tracheal homografting

THE management of patients with stenosis of the cervical trachea remains a difficult clinical problem. During the last decade, the two main aetio-logical factors have been the steady increase in Road Traffic Accidents and the ever increasing need for prolonged tracheal intubation. Looper (1938) pointed out that infection was being replaced by trauma as a main cause of laryngotracheal stenosis. The incidence of stenosis following tracheostomy with positive pressure ventilation has been reported as high as 20% (Pearson, et al., 1968). It is now generally agreed that sleeve resection of the damaged segment of the trachea, followed by end-to-end anastomosis without tension, offers the best prognosis. Grillo has shown that in this way it is possible to resect up to 10 rings of the cervical trachea without resorting to intra-pleural dissection. However, this method is limited in its application, and occasionally, the need arises for an alternative method of reconstruction of long segments of trachea. Experimental and clinical attempts to reconstruct the supporting rigid airway have been generally unsuccessful. A