[Reconstruction of an extensive anterior tracheal defect in a tetraplegic patient during long-term ventilation by autologous cartilage clasps within a pectoralis major flap].

Tetraplegic patients on permanent respirator therapy are likely to develop cuff related pressure ulceration of the trachea with subsequent tracheomalacia in the cuff level. Regional flaps for the reconstruction of anterior defects are insufficient due to the lack of rigidity and resulting intolerance of the cuff-pressure. Tracheal prostheses are not suitable in the inflammatory tissue in patients requiring continuous respirator therapy. A case report on a permanent reconstruction of an extensive anterior defect of the trachea employing a pedicled pectoralis--major flap incorporating autologous cartilage is presented. Due to "upside-down" rotation of the flap with the cartilage clasps implanted subcutaneously, an epithelialized reconstruction of the anterior tracheal wall was achieved in a length of 10 cm. Sufficient stability of this reconstruction is now given for 42 months.