To enhance the postoperative quality of life for total laryngectomy patients, a team led by Professor Chung-Kan Tsao at Linkou Chang Gung Memorial Hospital has developed the J-shaped tubular flap (J-flap) technique. This innovative approach utilizes the anterolateral thigh flap to simultaneously reconstruct the esophagus and voice tube, reducing postoperative complications while significantly improving the success rate of voice restoration, enabling patients to produce speech that closely resembles natural vocal cord sounds.

Limitations of Existing Techniques Affect Patients' Social and Daily Life

Patients who undergo total laryngectomy for hypopharyngeal or laryngeal cancer lose their natural vocal cord function. However, current voice restoration methods each have significant limitations. Artificial pneumatic voice devices and electrolarynxes produce highly mechanical, monotone speech, discouraging patients from using them in public settings. Tracheoesophageal puncture (TEP) provides a more natural-sounding voice, but the device has yet to be introduced in Taiwan and carries risks of infection and food leakage. Traditional intestinal flaps or forearm flaps for voice reconstruction often result in unstable speech quality and may impair swallowing function after reconstruction.

Dual-Lumen Reconstruction Enables 70% of Patients to Regain Speech and Normal Eating

The J-flap technique leverages the thick, pliable tissue of the anterolateral thigh flap to create a vertically oriented dual-lumen structure, simultaneously reconstructing the esophagus and voice tube, addressing the challenges of shaping these structures. Since 2014, the team has performed over 120 cases, achieving a 99% microsurgical success rate. Postoperative outcomes show that 70% of patients regain normal conversational abilities, with an average phonation duration of 8.9 seconds. After three to six months of speech therapy, patients can produce speech that closely resembles natural vocal cord sounds. In terms of swallowing function, 65% of patients can eat a normal diet, 20% can consume soft foods, and only 15% rely on a liquid diet.

This technique surpasses traditional methods in terms of speech stability, fluency, and clarity, significantly improving patients' communication abilities. Compared to intestinal flap surgery, the J-flap eliminates the need for an abdominal incision, reducing postoperative risks. When compared to forearm flaps, the J-flap has a lower leakage rate and provides greater vocal stability. The J-flap technique has been published in multiple international medical journals and presented at global conferences, receiving widespread academic recognition.

Advancing the Technique and Expanding Global Medical Collaboration

Professor Chung-Kan Tsao stated that his team will continue refining the reconstruction design to enhance surgical success rates and minimize complications. Physicians from Italy and Australia have already traveled to Taiwan to learn this technique and have begun performing the procedure in their respective countries. Additionally, three Taiwanese medical centers have sent doctors for training, with clinical applications now underway. Looking ahead, the team aims to expand into international medical collaborations, while also working with medical device companies to develop assistive surgical tools, ultimately helping more patients regain normal speech and quality of life.

Resource: 大腿皮瓣同步重建食道與發聲管 全喉切除患者重獲新「聲」