Long-Term Outcomes of Radial Forearm Free Flap Reconstruction of the Trachea.

Abstract

Long-segment tracheal defects present complex reconstructive challenges due to the risk of airway collapse and disrupted mucociliary clearance. Osteocutaneous radial forearm free flaps (RFFFs) offer a promising alternative to traditional reconstructive methods, though long-term outcome data remain limited. A previously-healthy 21-year-old male developed severe tracheal stenosis following prolonged intubation, tracheostomy, and multiple failed reconstructions. He underwent partial-circumference tracheal resection extending 41 mm from the larynx. Reconstruction was accomplished with a de-epithelialized osteocutaneous RFFF. The patient was decannulated within 6 months and experienced no breakdown of the bony reconstruction over 12.5 years of follow-up. He maintained stable respiratory function, diet tolerance, and speech, with no major complications or donor-site morbidity. Intermittent, elective endoscopic procedures addressed mild-to-moderate granulation and recurrent fibrosis. This case demonstrates successful use of a de-epithelialized osteocutaneous RFFF for tracheal reconstruction with over a decade of follow-up. It supports this technique as an effective, durable option in appropriately selected patients.