Defect classification and reconstruction algorithm for patients with tracheostomy using the tunneled supraclavicular artery island flap

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.