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J Thorac Cardiovasc Surg 2004;128:14-16
© 2004 The American Association for Thoracic Surgery

Editorial

Trachea-guided generation: Déjà vu all over again?

^a Department of Thoracic and Vascular Surgery, Heidehaus Hospital, Hannover Medical School, Hannover, Germany

Received for publication November 12, 2003; revisions received November 19, 2003; accepted for publication November 24, 2003.

^* Address for reprints: Paolo Macchiarini, MD, PhD, Department of Thoracic and Vascular Surgery, Heidehaus Hospital (Hannover Medical School), Am Leineufer 70, 30419 Hannover, Germany
pmacchiarini@compuserve.com

The first 300 words of the full text of this article appear below.

Tracheal surgery has matured to include techniques able to cure most lesions involving approximately half of the tracheal length in adults and probably a third in small children. Age, body build, local anatomy, type of pathology, and previous treatment may cause these limits of resection to fluctuate, but a safe primary reconstruction is almost always possible provided the surgeon respects the well-known surgical principles and uses anatomic mobilization procedures.¹ The complex problem of congenital tracheal stenosis has also been solved by slide tracheoplasty,² and even those benign lesions that are too lengthy for safe reconstruction nowadays can be successfully managed in the long-term with T-tubes or stents.³ It therefore appears that the clinical need for tracheal replacement is restricted to unresectable diseases—such as tracheopathia osteoplastica, relapsing polychrondritis, Wegener granulomatosis, trauma and low-grade malignancies in adults, and tracheal agenesis in neonates⁴—that are essentially treated with palliative measures and immunosuppression. Despite this, experimental research to generate a functional tracheal graft has been going on for a century and is currently under active investigation. Unfortunately, no predictable and dependable replacement has yet been found.⁵ This is not surprising, because an ideal graft must have some prerequisites: lateral rigidity and longitudinal flexibility, complete air tightness, biocompatibility, nonimmunogenicity, nontoxicity, resistance to bacterial colonization, freedom from the need for immunosuppression, permanent construction, ease of implantation, and the ability to provide a platform of ciliated respiratory epithelium resurfacing.

In this issue of the Journal, Kim and associates⁶ have combined the lessons learned from the past with the exciting research field of tissue engineering and experimentally developed a hybrid prosthetic graft that apparently fulfills almost all requirements for an ideal tracheal substitute. Conceptually, their working hypothesis is attractive. They first tissue engineered a viable autogenous mucosa by isolating abdominal skin epithelial cells and seeding them on . . . [Full Text of this Article]

This article has been cited by other articles:

				T. Walles, B. Giere, M. Hofmann, J. Schanz, F. Hofmann, H. Mertsching, and P. Macchiarini Experimental generation of a tissue-engineered functional and vascularized trachea J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 900 - 906. [Abstract] [Full Text] [PDF]