After pharyngolaryngoesophagectomy in 4 patients, free intestinal autografts were used for reconstruction. A microvascular technique and a simultaneous 2-team approach allowed this to be done immediately following the resection. No graft failures have occurred. Good function was present in 3 of the 4 patients at the last follow-up examination or at death. Follow-up intervals vary from 7-15 mo. postoperatively. Special problems, such as irradiation, tumor site and the relative merits of the large vs. the small intestine, are discussed.