목적: ALT flap is useful to reconstruct large defects of head and neck area. In cases of extensive and recurred head and neck cancer, all aerodigestive tract should be resected and reconstructed. The authors report reconstruction of large defects by bipaddled ALT flap in single staged operation. 방법:There were 4 patients, all of them were diagnosed squamous cell carcinoma in head and neck. And were treated with surgery and radiation therapy in samsung seoul hospital. The surgical procedure was done by head and neck specialist. The authors evaluated clinical features and results of bipaddled ALT free flap operation. 결과:Among 4 cases, 3 cases were tongue cancer, the other one was hypopharyngeal cancer. All cases were advanced and recurred, so Total glossectomy and total pharyngolaryngectomy were done. Reconstruction was done using bipaddled ALT free flap and covered oral cavity and pharynx for each by single staged. Radiation therapy was done to all patients but there was no fistula or dehiscence. Complications were 2 cases, skin wound infection and flap failure. 결론:Using bipaddled ALT free flap is good option in reconstruction of large defects by single staged operation.