The surgical treatment of irradiated head and neck cancer has been associated with high incidence of complications such as infection, necrosis, pharyngocutaneous fistula and carotid artery exposure which can lead to fatal artery rupture. One stage pectoralis major myocutaneous flap can be used to these complicated area with excellent reconstruction of pharyngeal, esophageal defect and good protection of carotid artery. In our department, we had experienced 2 cases of complications of irradiated head and neck cancer surgery which was impossible to control with conservative treatment. So, we used pectoralis major myocutaneous flap for the repair of pharyngostoma and protection of carotid artery with a good result.