Speech Rehabilitation with Free Lateral Upper Arm Flap after Total or Subtotal Laryngectomy in Patients with Advanced Laryngeal Cancer.

BACKGROUND

Restoration of speech after total laryngectomy (TLG) remains challenging. This study evaluated the feasibility of free lateral upper arm flap (LUAF) reconstruction of a laryngeal phonatory tube and compared postoperative voice outcomes with esophageal speech (ES).

METHODS

The authors retrospectively reviewed 74 men with advanced laryngeal cancer treated between 2019 and 2024. Twenty-three patients underwent LUAF reconstruction of a phonatory tube following TLG or subtotal laryngectomy, while 51 patients received postoperative ES training. Voice outcomes at 3 months were assessed using subjective ratings, objective acoustic measures, and voice-related quality-of-life questionnaires. The mean follow-up time was 28 months.

RESULTS

Twenty of 23 flaps survived uneventfully, and 3 patients developed transient pharyngeal fistulas. All patients in the LUAF group regained phonation, whereas 26 of 51 patients achieved ES. Compared with ES, LUAF reconstruction resulted in significantly better fundamental frequency, sound pressure level, maximum phonation time, harmonics-to-noise ratio, speech recognition, and lower speech effort (all P < 0.05). Daily communication satisfaction, speech naturalness, and intelligibility were comparable between groups, but swallowing function was inferior in the LUAF group ( P < 0.05). No tumor recurrence was observed in the LUAF cohort during follow-up.

CONCLUSIONS

Free LUAF reconstruction provides reliable restoration of phonation after TLG or subtotal laryngectomy with acceptable donor-site morbidity. Compared with ES, this technique enables more consistent voice acquisition and superior voice quality, representing a feasible reconstructive option for speech rehabilitation in selected patients with advanced laryngeal cancer.