Laryngotracheal reconstruction using free-tissue transfer represents one of the new challenges for the head and neck reconstructive surgeon. This article reviews the anatomy and physiology of the larynx and trachea and discusses the clinical context of laryngotracheal reconstruction, particularly with regard to malignant tumors involving the larynx and cervical trachea. It reviews the free-tissue reconstructive options, including the free forearm flap, the temporoparietal flap, and the two-staged procedure described by Delaere.