Inflammatory myofibroblastic tumor is extremely uncommon in the trachea. Surgery is recommended when airway obstruction becomes evident. The surgical technique and material used for repairing a massive tracheal defeat is a challenge for the thoracic surgeon. We present a case of repair and reconstruction of a massive defect of the thoracic trachea and right mainstem bronchus with a pectoralis major myocutaneous flap after resection of an inflammatory myofibroblastic tumor. The myocutaneous flap provides reliable material to repair and reconstruct a massive central airway defect. This novel surgical procedure may present new strategies for the treatment of extensive defects of the trachea. © 2009 The Society of Thoracic Surgeons.