Pharyngeal fistula staging and local drug changes: (1) red, swollen and purulent stage: after the pharyngeal fistula breaks down, there are more secretions discharged through the fistula hole during this period, and there is often necrotic tissue around the fistula, so the number of drug changes should be increased, the external mouth should be slightly enlarged to facilitate drainage, remove necrotic tissue, flush the fistula cavity with saline or hydrogen peroxide, and flush the pus cavity with sensitive antimicrobial agents according to the drug sensitivity test if available, or use saline diluted with 0.1% to 0.25% strong iodine if not available. If not, use 0.1% to 0.25% strong iodine diluted in saline to flush, 1 to 2 times/d. Place drainage strips and pressure bandages to eliminate the dead cavity for about 1 week to gradually reduce the secretions, from purulent secretions to exudate. Antibiotic powder can also be applied to the sinus tract, or 30% trichloroacetic acid can be used to cauterize the inner wall of the fistula and then apply moist burn cream. (2) Granulation period: This period is a period of strong tissue growth and rapid growth of granulation. If the granulation is slow, the fistula cavity should be filled with petroleum jelly or iodoform gauze to stimulate the growth of the granulation and make it grow from the inside out as much as possible, or to close the cavity with myogenic muscle. If you have a tumor, send it for pathological examination, and then flush it locally and place drainage strips. (3) Epithelial coverage period: the inner mouth will close pharyngeal fistula will heal quickly, the skin defect of the neck is epithelial coverage, should pay attention to the skin edge not to inwardly roll affect the healing. Application of human recombinant epidermal growth factor (goldin peptide): topical application of “goldin peptide” (rhEGF topical recombinant human epidermal growth factor derivative spray) can accelerate healing and reduce scarring. However, it is not effective when the infection is severe, so it should be applied after adequate flushing of the pus cavity. Drainage: It has been suggested that low negative pressure drainage, which is prolonged, has unsatisfactory efficacy. Mohadiger et al. concluded that a negative pressure of at least 9.3-13.3 kPa is required to completely drain the wound secretions and avoid reflux of secretions, and a greater negative pressure is required for stable wound closure. The treatment of early pharyngeal fistula is easy, safe and effective with strong negative pressure continuous suction. The correct and reasonable use of antibiotics: use sensitive antibiotics according to the results of drug sensitivity, pay attention to the balance of flora and reduce secondary infections. Nutritional support: In elderly, frail and malnourished patients, postoperative nutritional agents such as fresh plasma, albumin and fat milk are given as needed, and if necessary, gastrostomy can usually accelerate the healing of pharyngeal fistula. Surgical treatment: For those with local residual tumors, those who do not heal after more than 1 month of drug changes, those with fistula cavities that are too large to heal, those with severe infections and necrosis that require debridement, and those with large external skin wounds that cannot be repaired by the epithelium, surgical treatment is required. Surgery: flap repair, small anterior cervical band muscle flap, large pectoralis major muscle flap, thoracic deltoid muscle flap, trapezius muscle flap, sternocleidomastoid muscle flap, anterolateral femoral flap. Before transferring the flap, the inflammation of the skin around the fistula must be controlled first. The pectoralis major muscle flap has a reliable and thick blood supply, and it is more effective for repair. There are also clear sutures, local implants, and pharyngeal fistula repair. We have completed several cases of large pharyngeal fistulas after radiotherapy for laryngeal cancer with good prognosis. In addition, some scholars have cured two cases of very large pharyngeal fistulas by applying polypropylene mesh reinforced sutures, which proves that this method can be a new attempt to repair pharyngeal fistulas. In conclusion, the occurrence of pharyngeal fistula after laryngeal cancer is influenced by several factors before, during, and after surgery. A proper understanding of the high-risk factors for pharyngeal fistula formation, reduction of the effect of complications, non-invasive surgical techniques, application of tissue transfer during reconstruction, acid suppressants, and prophylactic antibiotics may reduce the occurrence of pharyngeal skin fistula.