title: Defect classification and reconstruction algorithm for patients with tracheostomy using the tunneled supraclavicular artery island flap.
abstract: OBJECTIVE
  Following long-term tracheostomy, reconstruction of the suprasternal notch and coverage of tracheocutaneous fistulas can be challenging. Often, aesthetic results are secondary to functional outcome. In this article, we propose a defect classification and a treatment algorithm using the tunneled supraclavicular artery island flap for functional and aesthetic reconstruction.
  
  
  METHODS
  Twelve patients requiring complete or partial closure of a tracheocutaneous fistula or soft tissue deficit reconstruction were treated with this pedicled flap. Support for the anterior tracheal wall was achieved by including fascia or bone into the flap.
  
  
  RESULTS
  Functional outcome was excellent, and suprasternal notch correction was achieved with good texture match. Donor sites could be closed primarily in every case. All flaps healed uneventfully, Long-term follow-up computed tomography scans demonstrated vital bone chips.
  
  
  CONCLUSIONS
  The proposed classification and treatment algorithm provides a structured approach to a successful surgical treatment of this complex condition.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hand Surgery, Burn Center, University Hospital of the RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany. npallua@ukaachen.de
authors.forename: Norbert
authors.initials: N
authors.lastname: Pallua
authors.forename: Timm Phillip
authors.initials: TP
authors.lastname: Wolter
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016025:Bone Transplantation / Q000379:methods; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting / Q000379:methods; D014057:Tomography, X-Ray Computed; D014139:Tracheostomy; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult