Background: The free ileocolon flap has been considered a safe method of simultaneous restoration of swallowing and voice production; however, the management of complications at the recipient site and its impact on functional outcomes are lacking in the literature. Methods: We reviewed retrospectively all consecutive patients with combined defects of the cervical esophagus and larynx reconstructed with free ileocolon flap between July 2005 and December 2009 (follow-up of ≥18 months). Patients were evaluated during the follow-up period to judge the impact of revision surgery on functional outcomes. Complications were reviewed, and the appropriate management was reported. Results: Swallowing function was restored in 69% of patient; functional speech function was achieved in 59%. Fourteen of the 29 patients underwent revision surgery because of complications or to improve functions at the recipient site. The mean functional improvement after revision surgery was 1.0 point on the 5-point Likert scale for speech and 1.1 point on the 7-point Likert scale for swallowing (P <.01 each). Conclusion: Continuous research over the last 10 years has allowed us to refine the technique and to make the outcome more predictable.