Wide resection of parastomal tissues after stomal recurrence significantly benefits patient survival. The defect thus created often requires coverage with a flap that provides (1) well-vascularized skin and soft tissue for uncomplicated wound closure and (2) pliable skin that can be inset easily around the often-shortened tracheal remnant. The radial forearm fasciocutaneous flap is ideal for these types of reconstructive problems. It should therefore be included on the reconstructive ladder for tracheostomy reconstruction both as a first choice and as a backup flap.