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Study Design Technical Note Objective Pharyngoesophageal injury in the setting of previous anterior cervical discectomy and fusion (ACDF) is a devastating complication with no standard corrective treatment protocol. Reconstruction can thus be a complex endeavour often leading to treatment failure, recurrent pharyngoesophageal fistula and need for multiple surgical procedures. The authors present our novel approach to free tissue reconstruction of these injuries. Methods We utilized a bulk adipofascial flap to completely obliterate the retropharyngeal space and correct the pharyngoesophageal defect. Results An adipofascial flap facilitates complete separation of the injured pharyngeal/oesophageal mucosa form the cervical spine and any retained hardware. Conclusions In our hands, this technique has allowed successful repair of complex pharyngoesophageal injuries after previous ACDF procedures which includes resumption of normal oral intake.