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An ideal substitute for injured tracheal tissues must have (1) biomechanical characteristics similar to the replaced tissues, (2) reliable vascular supply, (3) inner lining, and (4) skeletal framework.In May 2004, 5 patients with 1.2- to 2.3-cm tracheal defects were treated. Three patients presented with defects after tracheostomy (60%), 1 after intubation (20%), and 1 with traumatic lesion (20%). A prelaminated chrondromuscular axial flap in 2 stages was performed, including the sternohyoid muscle as a well-vascularized receptor bed and an auricular cartilage graft as donor tissue.A 1-year follow-up showed a tracheal function that recuperated completely. An endoscopic image demonstrated recuperation of the epithelial lining 3 months after surgery.This method is reliable because (1) the muscular vascularization permits a reliable survival of the ear auricular graft, (2) biomechanical characteristics of the replaced tissues are similar to those of native tracheal tissues, (3) regenerative lining epithelization is produced spontaneously, and (4) the alloplastic material is avoided.