Esophageal reconstruction: Combined application of muscle tissue flap and inner chitosan tube stent in rabbits
Abstract
BACKGROUND:
Esophageal reconstruction is the key issue in esophageal surgery. However, currently there is no satisfied technique to repair esophagus after surgery.
OBJECTIVE:
To combine an inner chitosan stent and a muscle tissue with vascular pedicle to repair the esophageal defect in cervical segment.
METHODS:
Esophageal defect was repaired using the combination of a muscle tissue flap and a chitosan tube stent in experimental group while only muscle tissue flap was utilized in controls for comparison. One animal in each group was sacrificed at week 3, 6 and 9 after operation respectively to exam the healing status. Barium X-ray was used to evaluate the esophageal status in 12 weeks.
RESULTS:
Histology showed the inflammatory response in 3 weeks after surgery, the chitosan stent was partially absorbed in 6 weeks, and there was no obvious fibrotic proliferation in experimental group; while the fibrotic proliferation and esophageal stenosis were obvious in controls, the chitosan stent was completely absorbed in 9 weeks, and squamous epidermis cells were observed. Twelve weeks later, the barium swallow went smoothly through the esophagus with noticeable peristalsis in the experimental group; esophageal stenosis without peristalsis was observed in controls.
CONCLUSION:
The combination of chitosan stent and muscle tissue flap is feasible to reconstruct a partial defect in esophagus.
References
[1] | Shen Q, , Shi P, , Gao M, , Yu X, , Liu Y, , Luo L, et al. Progress on materials and scaffold fabrications applied to esophageal tissue engineering. Mater Sci Eng C Mater Biol Appl. (2013) ; 33: (4): 1860. |
[2] | D'Journo XB, , Martin J, , Ferraro P, , Duranceau A. The esophageal remnant after gastric interposition. Dis Esophagus. (2008) ; 21: (5): 377. |
[3] | Ninomiya I, , Okamoto K, , Oyama K, , Hayashi H, , Miyashita T, , Tajima H, et al. Feasibility of esophageal reconstruction using a pedicled jejunum with intrathoracic esophagojejunostomy in the upper mediastinum for esophageal cancer. Gen Thorac Cardiovasc Surg. (2014) ; 62: (10): 627. |
[4] | Miyamoto S, , Kayano S, , Fujiki M, , Sakuraba M. Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction. Microsurgery. (2014) ; 34: (4): 319. |
[5] | Chen HC, , Kuo YR, , Hwang TL, , Chen HH, , Chang CH, , Tang YB. Microvascular prefabricated free skin flaps for esophageal reconstruction in difficult patients. Ann Thorac Surg. (1999) ; 67: (4): 911. |
[6] | Chen G, , Shi WJ. Lung tissue flap repairs esophagus defection with an inner chitosan tube stent. World J Gastroenterol. (2009) ; 15: (12): 1512. |
[7] | Parekh K, , Iannettoni MD. Complications of esophageal resection and reconstruction. Semin Thorac Cardiovasc Surg. (2007) ; 19: (1): 79. |
[8] | Lerut T, , Coosemans W, , Decker G, , De Leyn P, , Nafteux P, , van Raemdonck D. Anastomotic complications after esophagectomy. Dig surg. (2002) ; 19: (2): 92. |
[9] | Gaujoux S, , Le Balleur Y, , Bruneval P, , Larghero J, , Lecourt S, , Domet T, et al. Esophageal replacement by allogenic aorta in a porcine model. Surgery. (2010) ; 148: (1): 39. |
[10] | Le Baleur Y, , Gaujoux S, , Bruneval P, , Lambert B, , Larghero J, , Cattan P, et al. Self-expanding removable plastic stents for the protection of surgical anastomoses after esophageal replacement in a porcine model. Gastrointestendosc. (2010) ; 72: (4): 790. |
[11] | Freud E, , Efrati I, , Kidron D, , Finally R, , Mares AJ. Comparative experimental study of esophageal wall regeneration after prosthetic replacement. J Biomed Mater Res. (1999) ; 45: (2): 84. |
[12] | Horvath OP, , Cseke L, , Borbely L, , Vereczkei A, , Hobor B, , Lukacs L. Skin tube esophagus: present indications and late malignization. Dis Esophagus. (2000) ; 13: (3): 251. |
[13] | Totonelli G, , Maghsoudlou P, , Fishman JM, , Orlando G, , Ansari T, , Sibbons P, et al. Esophageal tissue engineering: a new approach for esophageal replacement. World J Gastroenterol. (2012) ; 18: (47): 6900. |
[14] | Kuppan P, , Sethuraman S, , Krishnan UM. Tissue engineering interventions for esophageal disorders - promises and challenges. Biotechnol Adv. (2012) ; 30: (6): 1481. |
[15] | Dooley TP, , Ellis AL, , Belousova M, , Petersen D, , DeCarlo AA. Dense chitosan surgical membranes produced by a coincident compression-dehydration process. J Biomater Sci Polym Ed. (2013) ; 24: (5): 621. |
[16] | Shi H, , Wang W, , Lu D, , Li H, , Chen L, , Lu Y, et al. Cellular biocompatibility and biomechanical properties of N-carboxyethylchitosan/nanohydroxyapatite composites for tissue-engineered trachea. Artif Cells Blood Substit Immobil Biotechnol. (2012) ; 40: (1-2): 120. |
[17] | Shi WJ, , Zhang SN, , Yang W, , Zhao JG, , Zhao Y, , Liu J. Clinical application and animal experiment of thoracic tracheal reconstruction by using pulmonary tissue flap. Zhonghuawaikezazhi. (2003) ; 41: (3): 218. |
