Abstract：
OBJECTIVE: Open surgery is a reliable choice for congenital subglottic stenosis, that represents the third most common congenital anomaly of the larynx. One of the procedures performed is anterior laryngotracheal reconstruction (LTR) with anterior rib graft. The objective of this preliminary study was to evaluate the potential of 3D printing technology for the realization of laryngo-tracheal scaffold in Polycaprolactone (PCL) implanted in vivo in ovine animal model.
METHODS: A 3D computer model of a laryngeal graft and a tracheal graft was designed and printed with PCL through 3D additive manufacturing technology. The scaffolds were seeded with autologous mesenchymal stem cells and cultured in vitro for up to 14 days. Anterior graft LTR with 3D printed scaffolds was performed on 5 sheep. The animals underwent endoscopic examinations at the first, 3rd, 6th, and 12th weeks after surgery and before sacrifice. The integration of the material was evaluated by the pathologist.
RESULTS: Two animals showed a favourable postoperative course and were sacrificed at 6 months postoperatively. In these cases, we observed endoscopically a complete integration of the cellularized PCL scaffold into the peri-implant tissues, and the pathologist found the growth of respiratory epithelium on the scaffold\'s inner surface. Other two animals showed a difficult post-operative recovery characterized by respiratory distress resulting in early sacrifice on postoperative days 31 and 33. In these animals we found a poor integration of the grafts into the tracheal structure, and a better integration of the laryngeal scaffold. The last animal developed a wound abscess and was sacrificed 80 days after surgery. We observed, in this case, a poor scaffold integration and an acute inflammatory reaction.
CONCLUSIONS: From the preliminary data obtained we found that the excessive stiffness of the material, along with the anatomical features of the sheep, is a major limitation of this study. It will be necessary in the future to create a new biocompatible, more flexible and elastic graft, to achieve greater integration into surrounding tissues. Bioconstructed grafts could simplify surgery for the treatment of laryngo-tracheal stenosis, particularly in the treatment of long tracheal stenoses, which have, at the moment, very complex surgical options.
METHODS: NA.
METHODS: A 3D computer model of a laryngeal graft and a tracheal graft was designed and printed with PCL through 3D additive manufacturing technology. The scaffolds were seeded with autologous mesenchymal stem cells and cultured in vitro for up to 14 days. Anterior graft LTR with 3D printed scaffolds was performed on 5 sheep. The animals underwent endoscopic examinations at the first, 3rd, 6th, and 12th weeks after surgery and before sacrifice. The integration of the material was evaluated by the pathologist.
RESULTS: Two animals showed a favourable postoperative course and were sacrificed at 6 months postoperatively. In these cases, we observed endoscopically a complete integration of the cellularized PCL scaffold into the peri-implant tissues, and the pathologist found the growth of respiratory epithelium on the scaffold\'s inner surface. Other two animals showed a difficult post-operative recovery characterized by respiratory distress resulting in early sacrifice on postoperative days 31 and 33. In these animals we found a poor integration of the grafts into the tracheal structure, and a better integration of the laryngeal scaffold. The last animal developed a wound abscess and was sacrificed 80 days after surgery. We observed, in this case, a poor scaffold integration and an acute inflammatory reaction.
CONCLUSIONS: From the preliminary data obtained we found that the excessive stiffness of the material, along with the anatomical features of the sheep, is a major limitation of this study. It will be necessary in the future to create a new biocompatible, more flexible and elastic graft, to achieve greater integration into surrounding tissues. Bioconstructed grafts could simplify surgery for the treatment of laryngo-tracheal stenosis, particularly in the treatment of long tracheal stenoses, which have, at the moment, very complex surgical options.
METHODS: NA.
摘要：
目的：开放手术是先天性声门下狭窄的可靠选择，这代表了第三常见的喉先天性异常。执行的程序之一是使用前肋骨移植的前喉气管重建（LTR）。这项初步研究的目的是评估3D打印技术在绵羊动物模型体内植入聚己内酯（PCL）中实现喉-气管支架的潜力。
方法：设计了喉部移植物和气管移植物的3D计算机模型，并通过3D增材制造技术用PCL打印。用自体间充质干细胞接种支架并在体外培养长达14天。在5只绵羊上进行具有3D打印支架的前移植物LTR。首先对动物进行了内窥镜检查，3rd,6th,手术后12周和处死前。病理学家评估了材料的整合。
结果：两只动物显示良好的术后病程，在术后6个月处死。在这些情况下,我们通过内窥镜观察到细胞化的PCL支架完全整合到植入物周围组织中，病理学家在支架的内表面发现了呼吸上皮的生长。另外两只动物显示出手术后难以恢复,其特征在于呼吸窘迫,导致在术后第31天和第33天早期处死。在这些动物中，我们发现移植物与气管结构的整合不良，和更好的整合喉部支架。最后的动物出现伤口脓肿并在手术后80天处死。我们观察到,在这种情况下,支架整合不良和急性炎症反应。
结论：从获得的初步数据中，我们发现材料的过大刚度，连同绵羊的解剖特征，是本研究的主要局限性。将来有必要创造一种新的生物相容性，更灵活和弹性的移植物，以实现与周围组织的更大整合。生物构建的移植物可以简化治疗喉-气管狭窄的手术，特别是在长气管狭窄的治疗中，其中有，此刻,非常复杂的手术选择。
方法：NA。
方法：设计了喉部移植物和气管移植物的3D计算机模型，并通过3D增材制造技术用PCL打印。用自体间充质干细胞接种支架并在体外培养长达14天。在5只绵羊上进行具有3D打印支架的前移植物LTR。首先对动物进行了内窥镜检查，3rd,6th,手术后12周和处死前。病理学家评估了材料的整合。
结果：两只动物显示良好的术后病程，在术后6个月处死。在这些情况下,我们通过内窥镜观察到细胞化的PCL支架完全整合到植入物周围组织中，病理学家在支架的内表面发现了呼吸上皮的生长。另外两只动物显示出手术后难以恢复,其特征在于呼吸窘迫,导致在术后第31天和第33天早期处死。在这些动物中，我们发现移植物与气管结构的整合不良，和更好的整合喉部支架。最后的动物出现伤口脓肿并在手术后80天处死。我们观察到,在这种情况下,支架整合不良和急性炎症反应。
结论：从获得的初步数据中，我们发现材料的过大刚度，连同绵羊的解剖特征，是本研究的主要局限性。将来有必要创造一种新的生物相容性，更灵活和弹性的移植物，以实现与周围组织的更大整合。生物构建的移植物可以简化治疗喉-气管狭窄的手术，特别是在长气管狭窄的治疗中，其中有，此刻,非常复杂的手术选择。
方法：NA。
