The pectoralis major myocutaneous flap has become a mainstay in reconstruction after ablative surgery for the head and neck cancer because of several advantages, such as easy technique, high reliability and success rate. Recently, free flap reconstruction is used more commonly than myocutaneous flap. In this aspect, this study explores the problem noted in our clinical practice with regard to the pectoralis major myocutaneous flap for the improvement of the efficacy. We have utilized this flap in 30 cases of reconstruction for neck(16 cases), hypopharynx(7 cases), oral cavity(5 cases), oropharynx(1 case), face(1 case) and hypopharynx with neck portion(1 case). The flap types which were included in this study were simple myocutaneous flap in 26 cases, combination with free flap in 2 cases, combination with skin graft in 1 case and sandwich in 1 case. In this series of 30 cases, there were 96.7% in success rate and pedicle spread of cancer cell in 4 cases. In 26 cases that followed up over 1 year, there were marked reduction in flap volume but poor color match. This results suggest that if the shortcomings of this flap and complete resectability of cancer would be resolved, the advantage of pectoralis major myocutaneous flap could be still attractive for reconstruction in variety of head and neck sites, especially after wide excision of recurrent cancer.