Tracheal Reconstruction With a Clavicle-attached Sternocleidomastoid Muscle Flap Tolerant to Positive Pressure Ventilation

Posttracheostomy wound allows for spontaneous closure of the fistula once it is no longer needed. However, a surgical closure is required when closure does not occur spontaneously. To date, only cases involving patients with spontaneous respiration have been reported. Here, we report successful treatment of a 29-year-old man with extensive tracheal wall tissue defects after tracheostomy, which allowed for the continuation of noninvasive positive pressure ventilation (NPPV) therapy. In this case, the patient presented with loss of spontaneous breathing resulting due to a cervical 4 (C4)-level spinal cord injury. After initial closure of the tracheostomy site, the patient developed an anterior neck abscess and a tracheocutaneous fistula associated with ongoing NPPV therapy. Multiple attempts to close the tracheostomy site resulted in extensive tracheal cartilage defects. In this case, we reconstructed the tracheal wall and neck soft tissue using a clavicle-attached pedicled sternocleidomastoid flap to provide a strong repair of the defect. As a result, the patient was able to continue noninvasive NPPV therapy, with no complications observed over the course of 8 years. This method for tracheal reconstruction provides the necessary strength to withstand NPPV therapy and could be recommended as an effective option in similar cases.