Purpose: Following long-term tracheostomy, reconstruction of the suprasternal notch and coverage of tracheocutaneous fistulas can be challenging. Often, aesthetic results are secondary to functional outcome. In this article, we propose a defect classification and a treatment algorithm using the tunneled supraclavicular artery island flap for functional and aesthetic reconstruction.
Methods: Twelve patients requiring complete or partial closure of a tracheocutaneous fistula or soft tissue deficit reconstruction were treated with this pedicled flap. Support for the anterior tracheal wall was achieved by including fascia or bone into the flap.
Results: Functional outcome was excellent, and suprasternal notch correction was achieved with good texture match. Donor sites could be closed primarily in every case. All flaps healed uneventfully, Long-term follow-up computed tomography scans demonstrated vital bone chips.
Conclusions: The proposed classification and treatment algorithm provides a structured approach to a successful surgical treatment of this complex condition.