Experimental tracheal reconstruction with a rotated right stem bronchus

Background. To reconstruct a longer tracheal defect, a safe method other than end-to-end anastomosis is necessary. Methods. Mne mongrel dogs underwent right thoracotomy. The lobes of the right lung other than the apical lobe were resected, keeping the bronchi in place to be manipulated to extend the right stem bronchial conduit. The trachea was resected for a 10-cartilage-ring length. The modified right stem bronchus was then brought into the mediastinum by rotation in the frontal plane. An end-to-end anastomosis was made. The right apical lobe, once separated, was then reanastomosed end-to-side. Ciliary transport was studied. Results. Eight of the 9 dogs tolerated the surgical procedure well, and the reanastomosed right apical lobe remained well expanded for 1 year or more postoperatively. The inverted segment did not show any cranial ciliary transport movement. Conclusions. A large tracheal defect more than 10 rings in length can be reconstructed using a rotated right stem bronchus with the right apical lobe reanastomosed. The inverted bronchial segment loses its cranial ciliary transport movement. (Ann Thorac Surg 2000,70:1886-90) (C) 2000 by The Society of Thoracic Surgeons.