Regenerative medicine approaches for the management of respiratory tract fistulas
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(2020) 11:451
REVIEW
Open Access
Regenerative medicine approaches for the management of respiratory tract fistulas Angelo Trivisonno1†, Dania Nachira2†, Ivo Boškoski3†, Venanzio Porziella2†, Giuliana Di Rocco4, Silvia Baldari4 and Gabriele Toietta4*
Abstract Respiratory tract fistulas (or fistulae) are abnormal communications between the respiratory system and the digestive tract or the adjacent organs. The origin can be congenital or, more frequently, iatrogenic and the clinical presentation is heterogeneous. Respiratory tract fistulas can lead to severely reduced health-related quality of life and short survival. Therapy mainly relies on endoscopic surgical interventions but patients often require prolonged hospitalization and may develop complications. Therefore, more conservative regenerative medicine approaches, mainly based on lipotransfer, have also been investigated. Adipose tissue can be delivered either as unprocessed tissue, or after enzymatic treatment to derive the cellular stromal vascular fraction. In the current narrative review, we provide an overview of the main tissue/cell-based clinical studies for the management of various types of respiratory tract fistulas or injuries. Clinical experience is limited, as most of the studies were performed on a small number of patients. Albeit a conclusive proof of efficacy cannot be drawn, the reviewed studies suggest that grafting of adipose tissue-derived material may represent a minimally invasive and conservative treatment option, alternative to more aggressive surgical procedures. Knowledge on safety and tolerability acquired in prior studies can lead to the design of future, larger trials that may exploit innovative procedures for tissue processing to further improve the clinical outcome. Keywords: Adipose tissue, Fistula, Regenerative medicine, Respiratory tract, Lipotransfer, Mesenchymal stromal cells, Head and neck, Tracheoesophageal fistula, Minimally invasive treatments, Airway defects restoration
Introduction Fat grafting, referred also as lipotransfer, involves harvesting of adipose tissue, processing of the collected fat to eliminate oil, liposuction fluids, and blood components, and then re-injection of the manipulated tissue into the area that needs treatment [1]. The first documented surgical fat grafting procedure dates back to 1893 when Gustav Neuber described the transfer of adipose tissue harvested from the forearm into the * Correspondence: [email protected] † Angelo Trivisonno, Dania Nachira, Ivo Boskoski and Venanzio Porziella contributed equally to this work. 4 Department of Research, Advanced Diagnostic, and Technological Innovation, Translational Research Area, IRCCS Regina Elena National Cancer Institute, via E. Chianesi 53, 00144 Rome, Italy Full list of author information is available at the end of the article
periorbital region to correct a depressed scar [2]. In 1987, Sydney R. Coleman developed an innovative technique of liposuction allowing for adipose tissue harvest under local anesthesia with less extensive d
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