Prosthetic airway reconstruction is seldom indicated in modern airway surgery because more than one-half the trachea can now be safely resected and the trachea be primarily reconstructed. In addition, an ideal prosthesis has yet to be developed with the use of those currently available being often associated with major morbidities and poor long-term outcomes. Recent developments in tracheal transplantation or tissue engineering strategies that promote and accelerate epithelial repair by controlling cell organization remains experimental, but showing great promise.