Pharyngocutaneous fistula is the problem that saliva leaks from the pharyx throughout a defect, usually appears after patients receive total laryngectomy. Some cases may be more difficult due to many predisposing factors, including radiation therapy. Primary closure may be the first treatment but may has a high failure rate in these cases. Followed salvage operation, like free jejunum flap, may be challenge. Thus, we provide a relatively simple method for intractable pharyngocutaneous fistula. A case with hypopharynx cancer received concurrent chemoradiotherapy and combined surgery of total laryngopharyngectomy plus tubing anterolateral thigh flap. Post-op leakage was noted. Primary suture failed though. Pedicled pectoralis major flap as tissue-plug method was used for salvage operation. Postoperative outcomes in the patient was satisfied.

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