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J Thorac Cardiovasc Surg 2005;129:1208
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Bioengineered airway tissue

Division of General Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114

To the Editor:

In the brief communication "First Human Transplantation of a Bioengineered Airway Tissue," Macchiarini and associates¹ point out that tracheal replacement by tissue engineering seems to hold potential. Question is to be raised whether this report actually does provide "definitive evidence that a tissue engineered patch...can functionally...fill all requirements for an airway patch."

The patch was applied to a defect 1.5 x 1.5 cm after breakdown of anastomosis after carinal pneumonectomy. Omentum was applied over the patch; this was further buttressed, and the space was filled with a subscapular muscle flap. To further obliterate the space, complementary thoracoplasty was performed. The leak healed, and ciliated respiratory epithelium was eventually found to cover the repaired defect.

Closure of a defect such as this with an omental flap, especially with further use of a muscle flap plus thoracoplasty to obliterate residual space, would in most cases suffice to seal the defect successfully. Epithelium undoubtedly migrates from the respiratory epithelium of the surrounding trachea and bronchus to cover the scar that forms over the mesenchymally repaired defect. Epithelization occurs over vascularized autogenous flaps used over smaller defects in trachea and bronchi. Whether the graft actually survived or the tissue ultimately seen was partly or entirely scar that would form over the mesenchymal bed of omentum is not demonstrated.

One must also question placement of a free graft of any tissue over an area that is still contaminated, even if not grossly infected, by the bacteria that necessarily are present in such a situation, despite all cleanup treatment before repair. More to the point, however, is the fact that defects of this sort have long been closed by vascularized pedicled autogenous tissues (omentum, pericardium, intercostal muscle, and other muscle flaps). Addition of an engineered tissue graft seems superfluous.

The potential of bioengineering to produce tracheal replacement segments in the future is a goal worthy of continued research attention nonetheless.

References

1. Macchiarini P, Walles T, Biancosino C, Mertsching H. First human transplantation of a bioengineered airway tissue. J Thorac Cardiovasc Surg. 2004;128:638-641.[Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hermes C. Grillo Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Grillo, H. C. Search for Related Content PubMed PubMed Citation Articles by Grillo, H. C. Related Collections Trachea and bronchi Molecular biology