Background: Tracheal reconstruction is challenging to surgeons. The difficulty is due to its unique location and structure. Following trauma or ablation of tumor, the defect can involve only partial wall or total circumferential, and the latter can be short or long segments. It is impossible to reconstruct with a single autologous tissue. Various methods had been tried with modest success, such as resection and primary anastomosis, periosteal flap, composite costal cartilage-perichondrium grafts, vscularized bone carrying a skin flap, forearm flap, etc. .

Methods: Three patients of tracheal defects had been reconstructed with free flaps: Two with free forearm flap and one with jejunum flap. Structural stability was maintained with costal cartilage or periosteum followed by prolonged stenting. In one patient the tracheal defect was due to trauma and in the other two it was due to cancer.

Results: One patient reconstructed with jejunum had recurrence of cancer at three months after surgery, however, he could leave the stent at two months because the tracheal defect was only located in the anterior wall. The other two patients of forearm flap could leave the stent at 6 months. One of them had a segmental defect of 3 cm and the other had partial circumference defect.

Conclusion: Tracheal efect of partial circumference or short segment can be reconstructed with free jejunum or forearm flap supported by cartilage or cortico-periosteum followed by long stenting. However, tracheotomy may need to be maintained whenever necessary in cases of longer segmental defects.