AbstractIntraoperative brachytherapy with radioactive Iodine 125 seeds using a pectoralis major myocutaneous flap for carotid artery coverage and primary repair was used in 10 patients with advanced oral and oropharyngeal carcinoma. There were no major complications such as orocutaneous fistula, carotid artery blowout, or wound breakdown. Fifty percent of the patients are alive without evidence of disease. By introducing a nonirradiated blood supply with the myocutaneous flap, re‐irradiation by brachytherapy is possible without significant complications. It is recommended that the use of intraoperative brachytherapy with125I seeds be entertained when surgery is indicated for advanced or recurrent oral or oropharyngeal cance