This is one of the rare tracheal transplants combined with cervical esophageal plastic surgery in world medical literature and has been successfully performed for the first time in Vietnam up to now.

Doctors at Viet Duc Friendship Hospital perform a tracheal transplant on a patient.

In July 2022, patient LVN (25 years old, Thanh Hoa) had a traffic accident and was diagnosed with multiple injuries, traumatic brain injury, maxillofacial injury, closed chest injury, liver injury, and underwent combined surgery on the maxillofacial bone, neck area, and conservative treatment of other damaged organs.

After surgery, the patient is monitored and treated with intensive care (with a tracheostomy: creating a hole in the neck to breathe without being able to breathe through the nose as usual). When stable, the patient is transferred to the local hospital for further treatment.

One month after tracheostomy, the patient was consulted for conservative treatment, dilation and stent placement failed, then tracheostomy was performed at a medical facility in Hanoi but was unsuccessful due to complex damage and stenosis on a long section of the trachea (after about 2 months, difficulty breathing appeared and the tracheostomy had to be permanently reopened).

During the recent treatment for cervical tracheal stenosis, when a permanent tracheostomy was not required, the patient ate and drank normally by mouth and received anti-scarring injections into the narrowed trachea (the patient received 6 injections, each injection 1-2 months apart).

In May 2023, after the 6th injection, the patient had milky discharge through the tracheostomy site. Gastroenterologists diagnosed a tracheoesophageal fistula at the anti-scarring injection site of the trachea and performed a gastrostomy for feeding.

The patient is still regularly examined at Viet Duc Friendship Hospital. For the past 2 years, the patient has not been able to eat by mouth (but must be fed through a gastric tube), and cannot breathe through the nose but through a tracheostomy in the neck (often with ulcers, bleeding, and infections at the tracheostomy site).

The patient's father and family were very pessimistic about the future of a young man who was able to work but was now disabled. Life seemed to be at a dead end. The patient and his father (who always followed his son to the doctor and for treatment) fell into a state of pessimism and depression...

Faced with the patient's complex injuries, doctors at Viet Duc Friendship Hospital held an interdisciplinary consultation (ENT, gastroenterology, thoracic surgery, rehabilitation, anesthesia, resuscitation, tissue banking, nutrition, etc.) and agreed to perform a two-stage surgery.

One is a plastic surgery to cut and reconnect the narrowed cervical esophagus or to create an esophagus using a colon segment; two are a plastic surgery to create a glottis segment combined with a neck tracheal segment grafted with a trachea segment from a brain-dead donor.

With careful preparation by a team of leading experts at Viet Duc Friendship Hospital, on April 11, 2024, the patient underwent surgery to reconstruct the cervical esophagus, cut the fibrous scar of the trachea, and prepare both ends of the trachea for the second surgery;

On May 13, 2024, the patient underwent surgery to transplant the cervical trachea using the trachea of ​​a brain-dead donor combined with tracheal stent placement, and bilateral sternocleidomastoid muscle transposition to cover the transplanted trachea.

After a period of intensive treatment, the patient was discharged from the hospital and returned home on June 25, 2024. The patient was re-examined after 1 month with good health (the patient gained 5kg), the surgical scar healed well, the patient was able to eat by mouth and breathe through the nose again.

Esophageal and tracheal endoscopy results: surgical scar healed well, tracheal graft was pink, no congestion, no necrosis, no stenosis.

After a 3-month check-up, the patient had gained 10kg with a healthy body, breathing through the nose and eating through the mouth. The patient is scheduled to have the tracheal stent removed in the 5th - 6th month.

The current condition of the patient and his father has completely changed: The patient has gained weight again, his health has improved, he can eat by mouth and breathe through his nose normally; Both the patient and his family are optimistic and happy again, and the family atmosphere is no longer tense and tired.

Up to now, tracheal transplantation in general and airway transplantation in particular are still a challenge in the surgical field and in the medical community around the world.

There are several short-term reports of tracheal segmental transplantation, but the results are modest and challenging, and there is no single most effective method for managing this type of lesion (tracheal segmental injury longer than 6 cm).

Specifically, how to choose the graft material, how to nourish the transplanted trachea, how to care for it after transplantation; is it necessary to use anti-rejection drugs or not?... All of the above issues were raised during the consultation process chaired by the Director of Viet Duc Friendship Hospital.

Furthermore, the clinical case of Viet Duc Friendship Hospital is very complicated due to two simultaneous injuries (both trachea and esophagus) in a young patient with an uncertain future ahead;

The problem of choosing how to treat these two types of injuries? When to perform? Post-operative care plan… has been carefully calculated and has good results as presented.

The results of this patient will open up a bright prospect for patients with tracheal lesions longer than 6cm (due to trauma, congenital stenosis or tumors...) to be able to restore the best airway.

Currently, Viet Duc Friendship Hospital with a team of high-quality human resources and leading experts in the field of organ transplantation combined with the support of international experts and the vision of the hospital's leaders, organ transplantation is a development focus. In addition to more routine implementation of multi-organ transplantation of liver, heart, kidney, lung, the hospital will implement many other types of transplantation in the near future, including tracheal transplantation, pancreas transplantation, intestinal transplantation... bringing many benefits to recipients that were not possible before.