S W Sung1, T Won. 1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 28 Yongon, Chongno, 110-744, Seoul, South Korea. swsung@snu.ac.kr
Abstract
OBJECTIVES: Donor airway ischemia is a significant problem after tracheal replacement with homograft or lung transplantation. Omentopexy is the usual countermeasure to prevent or overcome the ischemia of the airway but this is frequently not sufficient. This study was designed to investigate whether basic fibroblast growth factor (bFGF) can augment tracheal revascularization and its epithelial regeneration in rabbit tracheal autograft. METHODS: About half the length (44-45%) of the trachea of New Zealand white rabbit were autotransplanted in the original position immediately after harvest. In group I (n=15, control group), cervical tracheal autotransplantation was done only. In group II (n=15, omentopexy group), the cervical tracheal autograft was wrapped with subcutaneously advanced omentum. In group III (n=15, bFGF group), 1 microg of bFGF was applied evenly on the graft after the completion of anastomosis. Five animals in each group were examined on the 3rd, 7th and 14th postoperative days. Three rings of trachea were taken at the mid portion of the graft and the supra-carinal untouched normal trachea in each. The effect of revascularization was assessed by measuring the uptake of human serum albumin labeled with 99m technetium, which was injected into the left atrium just before sacrifice. The epithelial regeneration was assessed by means of light microscopic examination. RESULTS: The proportion of perfusion of the graft to normal trachea was much higher in group III (P<0.05) on day 3 (25.4, 27.8 and 54.7% in groups I, II and III, respectively), but there was no difference on the 7th and 14th days. The epithelial regeneration was better in group III (P<0.05) than in the other groups on day 3, and was better in groups II and III than group I on day 7. CONCLUSION: we concluded that bFGF enhances the revascularization and epithelial regeneration of the tracheal autograft, especially during their early phases.
OBJECTIVES:Donor airway ischemia is a significant problem after tracheal replacement with homograft or lung transplantation. Omentopexy is the usual countermeasure to prevent or overcome the ischemia of the airway but this is frequently not sufficient. This study was designed to investigate whether basic fibroblast growth factor (bFGF) can augment tracheal revascularization and its epithelial regeneration in rabbit tracheal autograft. METHODS: About half the length (44-45%) of the trachea of New Zealand white rabbit were autotransplanted in the original position immediately after harvest. In group I (n=15, control group), cervical tracheal autotransplantation was done only. In group II (n=15, omentopexy group), the cervical tracheal autograft was wrapped with subcutaneously advanced omentum. In group III (n=15, bFGF group), 1 microg of bFGF was applied evenly on the graft after the completion of anastomosis. Five animals in each group were examined on the 3rd, 7th and 14th postoperative days. Three rings of trachea were taken at the mid portion of the graft and the supra-carinal untouched normal trachea in each. The effect of revascularization was assessed by measuring the uptake of human serum albumin labeled with 99m technetium, which was injected into the left atrium just before sacrifice. The epithelial regeneration was assessed by means of light microscopic examination. RESULTS: The proportion of perfusion of the graft to normal trachea was much higher in group III (P<0.05) on day 3 (25.4, 27.8 and 54.7% in groups I, II and III, respectively), but there was no difference on the 7th and 14th days. The epithelial regeneration was better in group III (P<0.05) than in the other groups on day 3, and was better in groups II and III than group I on day 7. CONCLUSION: we concluded that bFGF enhances the revascularization and epithelial regeneration of the tracheal autograft, especially during their early phases.