Total pharyngeal reconstruction was performed using a pectoralis major myocutaneous flap. In this technique, the posterior wall of the neopharynx consists only of the prevertebral tissue, while the flap forms the anterior and lateral walls. The posterior wall heals by reepithelialization of the prevertebral fascia. Clinical experience with seven patients has shown that this technique provides a wide conduit and is not prone to develop stenosis. © 1988, American Medical Association. All rights reserved.