Intestinal Free Flaps and "J"-Designed Anterolateral Thigh Free Flap for Pharyngoesophageal and Voice Tube Reconstruction in Patients with Laryngopharyngectomy Defects.

Total laryngopharyngectomy for advanced hypopharyngeal and laryngeal cancers results in complex defects that compromise both swallowing and phonation. Restoration of these functions is critical for quality of life, yet reconstructive options present unique challenges. This study evaluates the outcomes of free ileocolon flaps and J-designed anterolateral thigh (J-ALT) flaps for simultaneous reconstruction of the pharyngoesophagus and voice conduit in patients undergoing total laryngopharyngectomy. Between 1988 and 2025, 231 patients underwent ileocolon flap reconstruction, and from 2014 to 2025, 124 patients underwent J-ALT flap reconstruction. Technical refinements, including plication of the ileocecal valve and precise flap inset, were implemented to optimize swallowing and phonation. In the ileocolon cohort, overall flap survival was 97%, with low rates of fistula and anastomotic complications; 78% of patients achieved good swallowing function, and 64% demonstrated satisfactory speech outcomes. The J-ALT flap demonstrated comparable swallowing outcomes, with 97% of patients resuming oral intake and 50% achieving fluent speech through the neophonation tube. Both techniques avoided the complications associated with tracheoesophageal prostheses, including obstruction, infection, and mechanical failure. These findings highlight that meticulous surgical planning and a multidisciplinary approach can achieve reliable long-term restoration of alimentary and vocal function. Both ileocolon and J-ALT flaps represent viable reconstructive options for patients with a favorable life expectancy.