[Median thoracic flap with cartilage for repair of large tracheal defect]

Large defect of the tracheal wall is very difficult to repair without support of cartilage. Two patients with large defect of the tracheal anterior wall (2.5-3.0 x 6.0 cm) were treated successfully. For the patients with much scar in neck a median thoracic flap (3.5 x 4.0 x 7.0 cm) was designed as follow: The flap was elevated, and 3 autocartilage bows (0.5 x 0.4 x 0.4 cm) were implanted into the separated tunnels just beneath the subdermal vascular plexus of the flap. The flap was sutured at the border of tracheal wall defect. The cartilage bows were fixed and covered with a combined cervico-thoracic and cervico-acromial bilobate flap. 13 cadavers showed that 1-2 stem vessels (n = 9) or 4-5 vascular branches (n = 4) developed in the flap.