A composite graft from the rabbit ear, consisting of cartilage, perichondrium and oral mucosa, was transposed to reconstruct a defect in the thyroid cartilage of the larynx in 10 rabbits. Five grafts were transposed as an island on an intact neurovascular pedicle; the other 5 were performed as a free graft without vascularization. After 9 weeks all the rabbits with a vascularized cartilaginous graft survived, with no sign of respiratory distress. The internal lining of the newly formed larynx was composed of undifferentiated stratified squamous cell epithelium. The survival of an intact cartilage and mucosa prevented a serious scar reaction in the neo-larynx and maintained the patency of the restored lumen. In the rabbits with non-vascularized cartilaginous grafts, there was necrosis present within the mucosal grafts, with intensive formation of granulation tissue in the transplanted region and retraction of the lumen. The present study highlights the importance of using well-vascularized composite cartilaginous grafts in laryngeal reconstruction. The possibility of utilizing a vascularized cartilaginous graft in man is discussed.