Postoperative pharyngocutaneous fistula is a common complication after total laryngectomy. A 58-year-old man had a pharyngocutaneous fistula after a total laryngectomy. Because of the prolonged hospital stay and expensive postoperative care, he refused to stay in the clinic until fistula closure. After 7 months, he returned with a hairy neck skin flap in the fistula region. This case emphasizes the importance of appropriate postoperative wound care and the possibility of neck skin curling throughout the fistula tract during fistula closure. © 2010 Buddhist Compassion Relief Tzu Chi Foundation.