Reconstruction of Long Trachea Defects by Trachea Allo-transplantation withCessation of Immunosuppression. Learning Curve after 9 cases.

The trachea is an enigmatic organ due to its complex morphology and definitive treatment of defects are challenging. Reconstructive options largely depend on the remaining structural cartilaginous support around the defect. For short tracheal defects, we have moved from a 2-stage cartilage-prelaminated radial forearm flap, towards a 1-stage mucosa-laminated flap to restore the hollow mucosa-lined lumen. Alternatives are medial condylar flaps or cartilage-loaded fascia flaps. For long airway defects there are no authentic autologous donor tissues available to restore the mucosa-lined elastic cartilaginous framework consistently. When autologous options are not stable over time, a useful and fascinating approach for difficult-to-repair long airway defects is tracheal allotransplantation.