ObjectiveTo discuss the clinical value of free posterior tibial artery perforator flap in the reconstruction of defects after preserving laryngeal function surgery in locally advanced hypopharyngeal carcinoma.MethodsClinical data of 20 patients with free posterior tibial artery perforator flap to preserve laryngeal function in hypopharyngeal carcinoma surgery hospitalized in our department from Aug 2009 to Jan 2019 were analyzed retrospectively. All the patients were male, aged from 47 to 67 years old. The pathological types of the tumor were all squamous cell carcinoma. The primary sites of the tumor were located in piriform sinus in 14 cases and hypopharyngeal wall in 6. The area sizes of the flaps were (4 cm×7 cm) to (7 cm×12 cm). Abdominal fullthickness skin graft was transplanted to the calf donor site. All patients underwent postoperative chemoradiotherapy.ResultsAll flaps survived with neither flap necrosis nor vascular crisis. Postoperative hypoproteinemia, pulmonary infection, pharyngeal fistula and donor skin necrosis occurred in 6, 4, 4 and 1, respectively. All patients underwent oral feeding after removal of the nasogastric tube, and one got secondary laryngeal stenosis. As for the oncologic outcomes, one of the 2 patients with local recurrence underwent salvage total laryngectomy and another one died, 2 cases with cervical lymph node metastasis underwent radical neck dissection.ConclusionWith advantages of constant anatomy of the perforating vessels, moderate thickness, long vascular pedicle and concealed donor site as well as good tolerance to postoperative radical radiotherapy, free posterior tibial artery perforator flap is one of the ideal choices for reconstruction of defects after hypopharyngeal carcinoma surgery.