Objective To investigate the effectiveness of various materials in reconstruction of laryngotracheal framework and to analyze the advantages, disadvantage, and indication of each material. Methods The cl inical data were retrospectively analyzed, from 337 laryngotracheal stenosis patients undergoing laryngotracheal framework reconstruction with various materials between October 1986 and October 2006. There were 229 males and 108 females aged from 2 to 54 years (median, 23.5 years). According to Cotton’s grading criteria for laryngotracheal stenosis, there were 94 cases of grade II, 218 cases of grade III, and 25 cases of grade IV, and all accompanied by laryngotracheal framework defect of 1-5 cm. The costal cartilage autograft was performed in 157 cases, thyroid cartilage graft in 27 cases, nasal septal cartilage graft in 8 cases, sternohyoid myocutaneous rotary door flap graft in 104 cases, hyoid bone flap of sternocleidomastoideus graft in 7 cases, musculo-periosteum flap of sternocleidomastoideus with clavicular periosteum in 21 cases, hydroxyapatite artificial tracheal ring graft in 10 cases, and pedicle myocutaneous flap with “C” shape nickel-titanic alloy net graft in 3 cases. Silastic T-tube was used after reconstruction for 6-12 months. Results Infection occurred in 5 cases and the incisions healed by second intention, the others achieved healing of incision by first intention. Intratracheal granulation formation occurred in 23 cases and choke when taking food in 6 cases; they were all cured after symptomatic treatment. After operation, 4 cases failed to be followed up and 12 cases did not recover, including 6 cases of costal cartilage autograft, 1 case of hyoid bone flap of sternocleidomastoideus graft, and 5 cases of sternohyoid myocutaneous rotary door flap graft. A total of 321 patients were followed up for 1-10 years (mean, 3.5 years). The patients had no laryngotracheal restenosis with good swallowing function and respiratory function. Conclusion Different materials of laryngotracheal framework reconstruction have advantages and disadvantage respectively. The appropriate material should be selected according to the special details of pathological change, and the satisfactory curative effect may be obtained.
Objective To explore the application and research progress of tissue-engineered scaffolds in the treatment of long-segment laryngotracheal stenosis (LTS). MethodsA comprehensive review of relevant domestic and international literature was conducted to summarize and analyze the application of different tissue-engineered scaffolds in the treatment of long-segment LTS, including the use of natural materials, synthetic polymers, their composite materials, and biodegradable metals. Results Conventional treatment methods for long-segment LTS are often limited in efficacy and associated with a high risk of complications. Tissue-engineered scaffolds can simulate the extracellular matrix and provide a suitable microenvironment for cellular growth, effectively supporting and promoting the repair and regeneration of laryngotracheal tissues. However, different scaffold materials exhibit distinct characteristics in terms of performance and clinical application. Natural materials offer good biocompatibility but insufficient mechanical strength and overly rapid degradation; synthetic polymers provide tunable mechanics but weak bioactivity and a tendency to induce inflammation; composite materials integrate the advantages of both, combining bioactivity with structural strength; biodegradable metal stents possess high mechanical strength and favorable degradability, but optimization of corrosion rate and the safety of degradation products is still required. ConclusionTissue-engineered scaffolds offer a novel therapeutic approach for long-segment LTS. However, further research and optimization of scaffold materials and design are required to enhance treatment efficacy and clinical outcomes.