Background/purpose Free costal cartilage graft for the treatment of subglottic and tracheal stenosis is widely used, but postoperative granulation formation i s a problem. To reduce the risk of granulation formation after free costal graft , a new operation of costal cartilage graft with vascular pedicle was introduced . Methods A vascular pedicled fifth costal cartilage graft is prepared using int ernal thoracic artery and vein and intercostal artery and vein as a vascular ped icle. The prepared graft is brought to the upper trachea. The anterior wall of c ricoid is split, and the costal cartilage graft is implanted to the split part a nd tracheostomy. Extubation on the next day is possible if the general condition of the patient permits. Results In 3 cases of subglottic or upper tracheal sten osis, this operation was performed. All the patients had tracheostomy made durin g early infancy. The postoperative course was uneventful, and all the patients w ere extubated soon after the operation. No granulation tissue was obserbed by po stoperative bronchoscopic examinations. Conclusions Costal cartilage graft with vascular pedicle is a safe and useful new operation for the treatment of subglot tic and upper tracheal stenosis. There also is a possibility of using this proce dure for the treatment of long segment tracheal stenosis. Background / purpose Free costal cartilage graft for the treatment of subglottic and tracheal stenosis is widely used, but postoperative granulation formation isa problem. To reduce the risk of granulation formation after free costal graft, a new operation of costal cartilage graft with vascular pedicle was introduced . Methods A vascular pedicled fifth costal cartilage graft is prepared using int ernal thoracic artery and vein and intercostal artery and vein as a vascular pedicle. The prepared graft is brought to the upper trachea. The anterior wall of c ricoid is split, and the costal cartilage graft is implanted to the split part a nd tracheostomy. Extubation on the next day is possible if the general condition of the patient permits. Results In 3 cases of subglottic or upper tracheal stenosis, this operation was performed. tracheostomy made durin g early infancy. The postoperative course was uneventful, and all the patients w ere extubated soon after the ope ration. No granulation tissue was obserbed by po stoperative bronchoscopic examinations. Conclusions Costal cartilage graft with vascular pedicle is a safe and useful new operation for the treatment of subglot tic and upper tracheal stenosis. There is is a possibility of using this proce dure for the treatment of long segment tracheal stenosis.