Protein scaffold trachea3/12/2023 2 The tracheal lumen is generally ovoid in shape although variations appear even without disease. 4 The tracheal walls are composed of 15–20 incomplete cartilaginous rings joined together by fibrous tissue and smooth muscle. The submucosa is rich in elastin, submucosal glands, and smooth muscle. 3, 4 The microanatomy of the trachea consists of a pseudostratified ciliated epithelium composed of ciliated cells, goblet cells, basal cells, and neuroendocrine cells 4, 5 ( Fig. The trachea functions as a conduit for ventilation, clears secretions, warms, humidifies and cleans the air for the respiratory zone, and keeps the airway free of foreign material through coughing and intrinsic defense mechanisms. In the thorax, it is crossed by the brachiocephalic artery and the left brachiocephalic vein. The carotid sheath and inferior thyroid artery are lateral to the trachea, the esophagus-posterior, and the recurrent laryngeal nerve lies in the groove between the two. 1 In the neck, it is covered by the cervical fascia and infrahyoid muscles, crossed by the isthmus of the thyroid and the jugular venous arch. Anteriorly, it is composed of horseshoe-shaped cartilagenous rings making up two thirds of its circumference and posteriorly by a membranous portion connecting the rings. The trachea connects the larynx to the carina, extending from the cricoid cartilage to its bifurcation into the left and right main bronchi. The main lesson learned from such failures is that the trachea must not be treated as a “simple tube.” Understanding the anatomy, developmental biology, physiology, and diseases affecting the trachea are required for solving this problem. Multiple attempts at replacing the trachea with synthetic scaffolds have been met with failure. Novel techniques such as tissue-engineering approaches will also be discussed. These along with the anatomy, indications, and approaches including microsurgical tracheal reconstruction will be reviewed. A myriad of attempts at replacing the trachea have been described. The trachea functions as a conduit for air, and its subunits including the epithelial layer, hyaline cartilage, and segmental blood supply make it particularly challenging to reconstruct. ![]() The work cannot be changed in any way or used commercially.Ī recent revival of global interest for reconstruction of long-segment tracheal defects, which represents one of the most interesting and complex problems in head and neck and thoracic reconstructive surgery, has been witnessed. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. Siba Haykal, MD, PhD, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario M5G 1V7, Canada, E-mail: ![]() The Article Processing Charge was paid for by the authors. Received for publication Septemaccepted March 24, 2014.ĭisclosure: The authors have no financial interest to declare in relation to the content of this article. From the *Latner Thoracic Surgery Research Laboratories, Division of Thoracic Surgery, University Health Network and McEwen Centre for Regenerative Medicine, Toronto, Ontario, Canada and †Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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