Tracheo-innominate artery fistula (TIF) is a rare but frequently fatal complication after tracheostomy. Without operation, the mortality is nearly 100% because of acute massive tracheal hemorrhage. Although the survival rate is extremely low, survival is possible only when an immediate operation is performed. Many surgeons have chosen ligation or resection of the innominate artery because repair with blood flow maintained in the innominate artery carries a high risk of postoperative fatal recurrent bleeding. We report on a successful surgical management of one case by patch closure with an innominate vein flap, wrapping of the innominate artery with a pericardial flap, and interposition of a thymus pedicle flap between the innominate artery and the trachea. Our surgical procedure is effective in maintaining the patency of the innominate artery preventing neurological deficits, and in preventing postoperative recurrent bleeding.