Download PDF
Semin Plast Surg 2025; 39(04): 216-224
DOI: 10.1055/s-0045-1812866
Review Article

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

Authors

  • Chung-Kan Tsao

    1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
    2   Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan

  • Rushil R. Dang

    1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
    3   Division of Oral and Maxillofacial Surgery, Henry Ford Hospital, Detroit, Michigan, United States

  • Hung-Chi Chen

    4   Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
Further Information
Also available at
   Permissions and Reprints

Abstract

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.

Keywords

J-flap - intestinal flaps - laryngopharyngectomy - pharyngoesophageal reconstruction


Publication History

Article published online:
18 December 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Seidenberg B, Rosenak SS, Hurwitt ES, Som ML. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 1959; 149 (02) 162-171
    Search in Google Scholar
  • 2 Yu P, Hanasono MM, Skoracki RJ. et al. Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer 2010; 116 (07) 1718-1724
    Search in Google Scholar
  • 3 Tsai YS, Chen YC, Chen TI. et al. Incidence trends of oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancers among males in Taiwan, 1980-2019: a population-based cancer registry study. BMC Cancer 2023; 23 (01) 213
    Search in Google Scholar
  • 4 Chien CY, Wang CP, Hung YW. et al. Comparison of the epidemiology of pharyngeal and oral cavity cancers in the U.S. and Taiwan. Oral Dis 2023; 29 (05) 2162-2171
    Search in Google Scholar
  • 5 Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nat Rev Dis Primers 2020; 6 (01) 92
    Search in Google Scholar
  • 6 Bova R, Goh R, Poulson M, Coman WB. Total pharyngolaryngectomy for squamous cell carcinoma of the hypopharynx: A review. Laryngoscope 2005; 115 (05) 864-869
    Search in Google Scholar
  • 7 Chang MF, Wang HM, Kang CJ. et al. Treatment results for hypopharyngeal cancer by different treatment strategies and its secondary primary–an experience in Taiwan. Radiat Oncol 2010; 5: 91
    Search in Google Scholar
  • 8 Kadota H, Fukushima J, Nakashima T. et al. Comparison of salvage and planned pharyngolaryngectomy with jejunal transfer for hypopharyngeal carcinoma after chemoradiotherapy. Laryngoscope 2010; 120 (06) 1103-1108
    Search in Google Scholar
  • 9 Chan YW, Ng RW, Liu LH, Chung HP, Wei WI. Reconstruction of circumferential pharyngeal defects after tumour resection: Reference or preference. J Plast Reconstr Aesthet Surg 2011; 64 (08) 1022-1028
    Search in Google Scholar
  • 10 Vasilakis V, Patel HD, Chen HC. Head and neck reconstruction using cephalic vein transposition in the vessel-depleted neck. Microsurgery 2009; 29 (08) 598-602
    Search in Google Scholar
  • 11 Shuangba H, Jingwu S, Yinfeng W. et al. Complication following gastric pull-up reconstruction for advanced hypopharyngeal or cervical esophageal carcinoma: A 20-year review in a Chinese institute. Am J Otolaryngol 2011; 32 (04) 275-278
    Search in Google Scholar
  • 12 Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993; 92 (03) 421-428 , discussion 429–430
    Search in Google Scholar
  • 13 Deschler DG, Doherty ET, Reed CG, Anthony JP, Singer MI. Tracheoesophageal voice following tubed free radial forearm flap reconstruction of the neopharynx. Ann Otol Rhinol Laryngol 1994; 103 (12) 929-936
    Search in Google Scholar
  • 14 de Carpentier JP, Ryder WD, Saeed SR, Woolford TJ. Survival times of Provox valves. J Laryngol Otol 1996; 110 (01) 37-42
    Search in Google Scholar
  • 15 Delsupehe K, Zink I, Lejaegere M, Delaere P. Prospective randomized comparative study of tracheoesophageal voice prosthesis: Blom-Singer versus Provox. Laryngoscope 1998; 108 (10) 1561-1565
    Search in Google Scholar
  • 16 Yang CC, Lee JC, Wu KC, Chang SH. Voice and speech outcomes with radial forearm free flap-accompanied phonation tube after total pharyngolaryngectomy of hypopharyngeal cancer. Acta Otolaryngol 2011; 131 (08) 847-851
    Search in Google Scholar
  • 17 Lee JC, Hsu WT, Yang CC, Chang SH. A fabricated forearm free flap with accompanying phonation tube for simultaneous reconstruction of a pharyngolaryngeal circumferential defect and voice loss: New surgical modification with functional phonation outcome. Laryngoscope 2013; 123 (02) 344-349
    Search in Google Scholar
  • 18 Hsieh YH, Fang TJ, Huang SF. et al. Synchronous reconstruction of esophageal defect and voice with J-flap after laryngopharyngectomy: Indications and outcomes. Oral Oncol 2020; 110: 104947
    Search in Google Scholar
  • 19 Tsao CK, Marchi F, Kang CJ. et al. Comprehensive evaluation of vocal outcomes and quality of life after total laryngectomy and voice restoration with J-flap and tracheoesophageal puncture. Cancers (Basel) 2022; 14 (03) 544
    Search in Google Scholar
  • 20 Ehrenberger K, Wicke W, Piza H, Roka R, Grasl M, Swoboda H. Jejunal grafts for reconstructing a phonatory neoglottis in laryngectomized patients. Arch Otorhinolaryngol 1985; 242 (02) 217-223
    Search in Google Scholar
  • 21 Chen HC, Patel H, Chen YC, Tang YB, Tan BK, Aydin A. Talking jejunum: a new, safe technique for voice reconstruction using free-jejunum transfer. Plast Reconstr Surg 2003; 111 (01) 336-340
    Search in Google Scholar
  • 22 Chen HC, Kim Evans KF, Salgado CJ, Mardini S. Methods of voice reconstruction. Semin Plast Surg 2010; 24 (02) 227-232
    Search in Google Scholar
  • 23 Leu YS, Hsiao HT, Chang YC. et al. Ileocolic free flap reconstruction, concomitant chemotherapy and radiotherapy and assessment of speech and swallowing function during management of advanced cancer of the larynx and hypopharynx: preliminary report. Acta Otolaryngol 2005; 125 (06) 642-646
    Search in Google Scholar
  • 24 Chen SH, Yeong EK, Tang YB, Chen HC. Free and pedicled appendix transfer for various reconstructive procedures. Ann Plast Surg 2012; 69 (06) 602-606
    Search in Google Scholar
  • 25 Chen HC, Tang YB, Mardini S, Chen SH. Transfer of Intra-Abdominal Organs for Advanced Reconstructions. 1st ed.. Taichung: Elsevier Taiwan; 2013: 146-149
    Search in Google Scholar
  • 26 Candelo E, Belafsky PC, Corrales M. et al. The global experience of laryngeal transplantation: Series of eleven patients in three continents. Laryngoscope 2024; 134 (10) 4313-4320
    Search in Google Scholar
  • 27 Lu YA, Pei YC, Chuang HF. et al. Speech performance after anterolateral thigh phonatory tube reconstruction for total laryngectomy. Laryngoscope 2021; 131 (06) 1349-1357
    Search in Google Scholar
  • 28 Lu YA, Tsao CK, Hsin LJ, Chuang HF, Fang TJ. Long-term assessment of speech and swallowing function in laryngopharyngeal cancer patients after J-flap reconstruction. Clin Exp Otorhinolaryngol 2024; 17 (04) 346-354
    Search in Google Scholar