ABSTRACT Background 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. Methods 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. Results 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. Conclusions 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.
Palmer et al. (2026) studied this question.