Reconstruction of the cervical trachea using a prefabricated corticoperiosteal flap from the femur

Ann Plast Surg. 2009 Jun;62(6):633-6. doi: 10.1097/SAP.0b013e31817f023e.


We treated a severe cervical fistula with a defect of tracheal cartilage using prefabrication of a corticoperiosteal flap combined with a cutaneous flap.The patient was a 16-year-old male with a cervical tracheal fistula that developed after a tracheostomy. Almost all the circumference of the trachea just below the cricoid cartilage up to the 4th tracheal cartilage had been lost.The reconstruction was performed in 2 series of operations as follows; repair of tracheal framework using a prefabricated corticoperiosteal flap, which was harvested from the femur and composed of a saphenous flap, and then complete closure using a local hinge flap and a free auricular cartilage graft. A free corticoperiosteal flap composed of a saphenous flap was transferred to the site just lateral to the defect. The corticoperiosteal flap, which has a flat shape, was bent in a reverse U-shaped semitubular fashion and the mucosal grafts were used to cover its inner surface. Two months later, the prefabricated corticoperiosteal flap and the saphenous flap were transposed leaving a part of the fistula as a tracheostoma. The remaining tracheostoma was closed secondarily. A satisfactory and stable result was obtained over an 8-year follow-up period.We believe that the procedure demonstrated here should be considered as a choice for the stable reconstruction of a cervical trachea.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Femur / transplantation*
  • Graft Survival
  • Humans
  • Male
  • Neck
  • Plastic Surgery Procedures / methods*
  • Reoperation
  • Respiratory Tract Fistula / etiology
  • Respiratory Tract Fistula / surgery*
  • Surgical Flaps
  • Trachea / surgery*
  • Tracheal Diseases / etiology
  • Tracheal Diseases / surgery*
  • Tracheal Stenosis / etiology
  • Tracheal Stenosis / surgery
  • Tracheostomy / adverse effects*
  • Wound Healing
  • Wounds and Injuries / surgery