Processing of Fascia for Vocal Fold Injection

Abstract

To evaluate the simplest and safest method to mince fascia for autologous vocal fold injection, we performed an in vitro study applying porcine fascia and a prospective study using a canine model. Six different surfaces were tested in the laboratory for mincing fascia. The ease of handling of tissue on each surface was noted. Minced fascia was studied by microscope under polarized illumination, and the number and nature of foreign particles were recorded. After the safest method to mince fascia was established, 2 dogs were operated on. The recurrent nerve was sectioned, and a piece of fascia lata was harvested and cut with scissors on a steel surface. Fascia injection deep into the thyroarytenoid muscle was performed. The dogs were painlessly sacrificed 6 months later, and the larynges were removed for histomorphological study. On cutting, all polymer surfaces released small amounts of particles. These were not evident when we used glass or steel plates, but their hard surfaces were difficult to work on. Cutting a piece of fascia with scissors was found to be effective and safe in terms of microscopic foreign particles. The two dogs suffered no perioperative or late complications. Six months later, a well-preserved, vascularized, collagen-rich tissue was in its place without any evidence of acute or chronic inflammation. The histomorphological findings were identical to those of our previous study, with the exception that this time, no foreign particles from the mincing surface were present. An autologous fascia graft proves to be well preserved and well tolerated in the augmentation of a paralyzed vocal fold, and scissors are simple and effective in mincing it for injection.