<p>Reconstructing large, near-circumferential tracheal defects is a major surgical challenge, often resulting in severe stenosis and failed decannulation. We report a novel reconstructive approach using a “butterfly-shaped” bilateral deltopectoral (DP) flap. A 58-year-old male presented with a recurrence of squamous cell carcinoma in the suprasternal fossa, invading the anterior and lateral walls of the trachea. A radical resection was performed, preserving the posterior tracheal wall. The defect was reconstructed using bilateral DP flaps rotated medially. Most importantly, no internal silicone stent or T-tube was used. The patient recovered without complications and was successfully decannulated 15 weeks postoperatively. Endoscopic follow-up confirmed a patent airway with no stenosis. One year later, the persistent tracheostoma was successfully closed using a local turnover flap. This case shows that bilateral deltopectoral flap reconstruction is a feasible strategy for managing large tracheal defects. The opposing tension provided by the butterfly configuration supports the airway lumen, potentially reducing the risk of stenosis and enabling successful decannulation without permanent stenting.</p>