Tracheal Replacement Using an In-Body Tissue-Engineered Collagenous Tube “BIOTUBE” with a Biodegradable Stent in a Beagle Model: A Preliminary Report on a New Technique

2018 ◽  
Vol 29 (01) ◽  
pp. 090-096 ◽  
Author(s):  
Yasuhide Nakayama ◽  
Satoshi Umeda ◽  
Yuichi Takama ◽  
Takeshi Terazawa ◽  
Hiroomi Okuyama ◽  
...  
Keyword(s):  
Internal Surface ◽  
Body Tissue ◽  
Histological Evaluation ◽  
Biodegradable Stent ◽  
Tracheal Reconstruction ◽  
Tracheal Epithelial Cells ◽  
Biodegradable Stents ◽  
Tracheal Replacement ◽  
A New Technique ◽  
Novel Scaffold

Introduction Tracheal reconstruction for long-segment stenosis remains challenging. We investigate the usefulness of BIOTUBE, an in-body tissue-engineered collagenous tube with a biodegradable stent, as a novel tracheal scaffold in a beagle model. Materials and Methods We prepared BIOTUBEs by embedding specially designed molds, including biodegradable stents, into subcutaneous pouches in beagles. After 2 months, the molds were filled with ingrown connective tissues and were harvested to obtain the BIOTUBEs. The BIOTUBEs, cut to 10- or 20-mm lengths, were implanted to replace the same-length defects in the cervical trachea of five beagles. Endoscopic and fluoroscopic evaluations were performed every week until the lumen became stable. The trachea, including the BIOTUBE, was harvested and subjected to histological evaluation between 3 and 7 months after implantation. Results One beagle died 28 days after 20-mm BIOTUBE implantation because of insufficient expansion and retention force of the stent. The remaining four beagles were implanted with a BIOTUBE reinforced by a strong stent, and all survived the observation period. Endoscopy revealed narrowing of the BIOTUBEs in all four beagles, due to an inflammatory reaction, but patency was maintained by steroid application at the implantation site and balloon dilatation against the stenosis. After 2 months, the lumen gradually became wider. Histological analyses showed that the internal surface of the BIOTUBEs was completely covered with tracheal epithelial cells. Conclusion This study demonstrated the usefulness of the BIOTUBE with a biodegradable stent as a novel scaffold for tracheal regeneration.

scholarly journals Dilation or biodegradable stent placement for recurrent benign esophageal strictures: a randomized controlled trial

Endoscopy ◽  
2018 ◽  
Vol 50 (12) ◽  
pp. 1146-1155 ◽  
Author(s):  
Daisy Walter ◽  
Maarten van den Berg ◽  
Meike Hirdes ◽  
Frank Vleggaar ◽  
Alessandro Repici ◽  
...  
Keyword(s):  
Stent Placement ◽  
Controlled Trial ◽  
Treatment Algorithm ◽  
Stent Group ◽  
Biodegradable Stent ◽  
Recurrent Stricture ◽  
Level Of Activity ◽  
Number Of Patients ◽  
Esophageal Strictures ◽  
Biodegradable Stents

Abstract Background Dilation is the standard of care for recurrent benign esophageal strictures (BES). Biodegradable stents may prolong the effect of dilation and reduce recurrences. Efficacy and safety of dilation and biodegradable stent placement early in the treatment algorithm of recurrent BES were compared. Methods This multicenter, randomized study enrolled patients with BES treated with previous dilations to ≥ 16 mm. The primary end point was number of repeat endoscopic dilations for recurrent stricture within 3 and 6 months. Secondary outcomes through 12 months included safety, time to first dilation for recurrent stricture, dysphagia, and level of activity. Results At 3 months, the biodegradable stent group (n = 32) underwent significantly fewer endoscopic dilations for recurrent stricture compared with the dilation group (n = 34; P < 0.001). By 6 months, the groups were similar. The number of patients experiencing adverse events was similar between the groups. Two patients in the biodegradable stent group died after developing tracheoesophageal fistulas at 95 and 96 days post-placement; no deaths were attributed to the stent. Median time to first dilation of recurrent stricture for the biodegradable stent group was significantly longer (106 vs. 41.5 days; P = 0.003). Dysphagia scores improved for both groups. Patients in the biodegradable stent group had a significantly higher level of activity through 12 months (P < 0.001). Conclusion Biodegradable stent placement is associated with temporary reduction in number of repeat dilations and prolonged time to recurrent dysphagia compared with dilation. Additional studies are needed to better define the exact role of biodegradable stent placement to treat recurrent BES.

Vascularization strategies for tissue engineering for tracheal reconstruction

2021 ◽  
Author(s):  
Fei Sun ◽  
Yi Lu ◽  
Zhihao Wang ◽  
Hongcan Shi
Keyword(s):  
Tissue Engineering ◽  
Cell Metabolism ◽  
Microvascular Network ◽  
Related Factors ◽  
Engineering Technology ◽  
Term Survival ◽  
Tracheal Reconstruction ◽  
Tracheal Replacement ◽  
Therapy Strategies

Tissue engineering technology provides effective alternative treatments for tracheal reconstruction. The formation of a functional microvascular network is essential to support cell metabolism and ensure the long-term survival of grafts. Although several tracheal replacement therapy strategies have been developed in the past, the critical significance of the formation of microvascular networks in 3D scaffolds has not attracted sufficient attention. Here, we review key technologies and related factors of microvascular network construction in tissue-engineered trachea and explore optimized preparation processes of vascularized functional tissues for clinical applications.

Initial Experience with Biodegradable Pancreatic Stents in the Prevention of Postoperative Pancreatic Fistula after Cephalic Pancreaticoduodenectomy

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Sanchez Bueno F ◽  
◽  
Gil Vazquez PJ ◽  
Ferreras D ◽  
Gomez B ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Randomized Study ◽  
Somatostatin Analogues ◽  
Postoperative Pancreatic Fistula ◽  
Initial Experience ◽  
Technical Success ◽  
Biodegradable Stent ◽  
Biodegradable Stents ◽  
Pancreatic Reconstruction ◽  
Pancreaticojejunal Anastomosis

Background: Postoperative Pancreatic Fistula (POPF) remains the most important morbidity after pancreaticoduodenectomy. There is no consensual technique for pancreatic reconstruction and many surgeons use a transanastomotic drain. Currently, the stents used are not degradable and they can cause obstruction, stricture and pancreatitis. The use of biodegradable stents that disappear a few months after the intervention could have a role in the prevention of pancreaticojejunostomy complications. The aim of the study was to evaluate technical success of implantation and safety of newly available biodegradable stents in 16 patients undergoing cephalic duodenopancreatectomy. Materials and Methods: A single-center prospective non-randomized study was conducted with patients undergoing PD. A total of 16 patients were included. A duct-to-mucosa end-to-side anastomosis was performed for the pancreaticojejunal anastomosis and the biodegradable stent (Archimedes) was placed from the pancreatic duct to the jejunum. Results: One of the patients developed POPF, which was successfully treated with interventional radiology drainage and somatostatin analogues. Completed degradation occurred after 3 months in all cases. There was no mortality at 30 days after PD. Conclusion: Based on our experience, the use of resorbable internal pancreatic prostheses could be a valid alternative to prevent POPF after a pancreaticoduodenectomy, also avoiding the main complications related to the use of non-absorbable prostheses.

Modeling of Coated Biodegradable Stents

2012 ◽  
Author(s):  
Nic Debusschere ◽  
Matthieu De Beule ◽  
Patrick Segers ◽  
Benedict Verhegghe ◽  
Peter Dubruel
Keyword(s):  
Material Model ◽  
Local Drug Delivery ◽  
Metallic Stent ◽  
Biodegradable Stent ◽  
Stent Restenosis ◽  
Biodegradable Stents ◽  
Bioresorbable Stent ◽  
Drug Eluting ◽  
Corrosion Modelling

A bioresorbable stent supports the stenosed blood vessel during the healing period after coronary angioplasty and then gradually disappears. Unlike permanent stents, the biodegradable stent forms no obstacle for future interventions. Moreover, the degradable stent material presents an ideal vehicle for local drug delivery. Long term side effects inherent to drug eluting stents such as in-stent restenosis and late stent thrombosis might be avoided [1]. To date, several bioresorbable stents are being developed or are currently being tested in clinical trials. Two classes of biomaterials are being used in biodegradable stent technology: biodegradable polymers and bioerodible metal alloys. Polymers can be tailored to have a well-defined degradational behaviour but have relatively poor mechanical properties. Biocorrodible metals such as magnesium alloys have good mechanical characteristics but display a more complex an less predictive degradational behaviour. A biocorrodible metallic stent coated with a biodegradable polymer might be able to combine the benefits of both metallic and polymeric biodegradable stents. Finite element modelling can play an important role in the study of nevel stent designs. To correctly simulate the behaviour of degradable stents a material model must be developed that incorporates the effect of degradation on all material characteristics. In case of a coated biocorrodible magnesium stent this includes corrosion modelling, the effect of the coating and the influence of mechanical loading on the corrosion rate.

scholarly journals Biodegradable Stent/Tube for Pancreatic and Biliary Disease

2020 ◽  
Vol 25 (1) ◽  
pp. 18-23
Author(s):  
Chang-Il Kwon
Keyword(s):  
Clinical Results ◽  
Raw Material ◽  
Constant Thickness ◽  
Biliary Disease ◽  
Biodegradable Stent ◽  
Human Organs ◽  
Biodegradable Stents ◽  
Long Time ◽  
Expansion Force ◽  
Degradation Time

Biodegradable stents have the highly attractive advantage that they do not need to be removed after insertion into human organs. For this reason, biodegradable stents using various biodegradable materials have been developed and applied to the several human organs for a long time with the possibility of success. In the gastrointestinal tract, benign esophageal stricture was the first indication of biodegradable stents, and several biodegradable stents are currently attempting to overcome several technical limitations and to be inserted benign bile duct and pancreatic strictures by endoscopic procedure. However, in order to maintain a high radial expansion force while properly controlling the degradation time, there are many problems to be solved because the thickness of the raw material must be adequately maintained at a constant thickness. In this review, the issues or previous clinical results related to biodegradable stents were reviewed, and the concepts of the basics and the problems related to the development of biodegradable stents were discussed.

W-Plasty Technique in Tracheal Reconstruction: A New Technique?

2008 ◽  
Vol 41 (4) ◽  
pp. 319-323 ◽  
Author(s):  
S. Han ◽  
U. Han ◽  
C. Atinkaya ◽  
T. Cavusoglu ◽  
G. Osmanoglu ◽  
...  
Keyword(s):  
New Technique ◽  
Tracheal Reconstruction ◽  
A New Technique

Tracheal Reconstruction with a Pleuroperiosteal Flap

1983 ◽  
Vol 91 (6) ◽  
pp. 610-614 ◽  
Author(s):  
Yosef P. Krespi ◽  
Hugh F. Biller ◽  
Se-Min Baek
Keyword(s):  
Soft Tissue ◽  
Experimental Work ◽  
Full Thickness ◽  
Tracheal Mucosa ◽  
Tracheal Reconstruction ◽  
Rigid Tube ◽  
Tracheal Defect ◽  
Tracheal Replacement ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

Reconstruction of extensive tracheal defects remains a difficult surgical problem. In many experiments restoration of tracheal mucosa by autogenous or homologous soft tissue grafts has usually failed because of rejection or tracheal obstruction. This experimental work employed a two-stage surgical procedure that allowed reconstruction of extensive circumferential full-thickness defects of the trachea. Stage I involved the creation of a vascularized pleuroperiosteal flap that was formed into a rigid tube around a Silastic stent. Stage II consisted of creation of a full-thickness circumferential tracheal defect and repair with the flap in those animals in which a suitable rigid tube had been formed. The results of these experiments argue strongly that a vascularized composite pleuroperiosteal flap can produce an adequate tracheal replacement.

scholarly journals Biodegradable Stent with mTOR Inhibitor-Eluting Reduces Progression of Ureteral Stricture

2021 ◽  
Vol 22 (11) ◽  
pp. 5664
Author(s):  
Dong-Ru Ho ◽  
Shih-Horng Su ◽  
Pey-Jium Chang ◽  
Wei-Yu Lin ◽  
Yun-Ching Huang ◽  
...  
Keyword(s):  
Signaling Pathway ◽  
Thermal Injury ◽  
Mtor Inhibitor ◽  
Ureteral Stricture ◽  
Type Iii Collagen ◽  
Biodegradable Stent ◽  
Mesenchymal Transition ◽  
Type Iii ◽  
Biodegradable Stents ◽  
Drug Eluting

In this study, we investigated the effect of mTOR inhibitor (mTORi) drug-eluting biodegradable stent (DE stent), a putative restenosis-inhibiting device for coronary artery, on thermal-injury-related ureteral stricture in rabbits. In vitro evaluation confirmed the dose-dependent effect of mTORi, i.e., rapamycin, on fibrotic markers in ureteral component cell lines. Upper ureteral fibrosis was induced by ureteral thermal injury in open surgery, which was followed by insertion of biodegradable stents, with or without rapamycin drug-eluting. Immunohistochemistry and Western blotting were performed 4 weeks after the operation to determine gross anatomy changes, collagen deposition, expression of epithelial–mesenchymal transition markers, including Smad, α-SMA, and SNAI 1. Ureteral thermal injury resulted in severe ipsilateral hydronephrosis. The levels of type III collagen, Smad, α-SMA, and SNAI 1 were increased 28 days after ureteral thermal injury. Treatment with mTORi-eluting biodegradable stents significantly attenuated thermal injury-induced urinary tract obstruction and reduced the level of fibrosis proteins, i.e., type III collagen. TGF-β and EMT signaling pathway markers, Smad and SNAI 1, were significantly modified in DE stent-treated thermal-injury-related ureteral stricture rabbits. These results suggested that intra-ureteral administration of rapamycin by DE stent provides modification of fibrosis signaling pathway, and inhibiting mTOR may result in fibrotic process change.

scholarly journals Tracheal replacement

2018 ◽  
Vol 51 (2) ◽  
pp. 1702211 ◽  
Author(s):  
Harry Etienne ◽  
Dominique Fabre ◽  
Abel Gomez Caro ◽  
Frederic Kolb ◽  
Sacha Mussot ◽  
...  
Keyword(s):  
Clinical Results ◽  
Research Field ◽  
Long Term Results ◽  
Malignant Tumours ◽  
Autologous Tissue ◽  
Tracheal Reconstruction ◽  
Working Solution ◽  
Tracheal Tissue ◽  
Tracheal Replacement

Tracheal reconstruction is one of the greatest challenges in thoracic surgery when direct end-to-end anastomosis is impossible or after this procedure has failed. The main indications for tracheal reconstruction include malignant tumours (squamous cell carcinoma, adenoid cystic carcinoma), tracheoesophageal fistula, trauma, unsuccessful surgical results for benign diseases and congenital stenosis. Tracheal substitutes can be classified into five types: 1) synthetic prosthesis; 2) allografts; 3) tracheal transplantation; 4) tissue engineering; and 5) autologous tissue composite. The ideal tracheal substitute is still unclear, but some techniques have shown promising clinical results. This article reviews the advantages and limitations of each technique used over the past few decades in clinical practice. The main limitation seems to be the capacity for tracheal tissue regeneration. The physiopathology behind this has yet to be fully understood. Research on stem cells sparked much interest and was thought to be a revolutionary technique; however, the poor long-term results of this approach highlight that there is a long way to go in this research field. Currently, an autologous tissue composite, with or without a tracheal allograft, is the only long-term working solution for every aetiology, despite its technical complexity and setbacks.

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