Carotid artery rupture (CAR) can occur in the postoperative settings like pharyngocutaneous fistula, tumor recurrence, infection, or local flap failure. Although resuscitation techniques have improved in recent years, CAR is still associated with a neurological morbidity of 60% and a mortality of 40%. CAR can be managed with endovascular embolization, stenting, prosthetic patch graft, or covering with flaps. Here we report carotid artery coverage with dermofat graft and Pectoralis Major Myocutaneous Flap (PMMC) in two patients, 63-year (CAR was reconstructed with synthetic patch graft first) and 83-year-old men. Complete incision was made in the subcutaneous tissue layer of the inguinal area (underwear line), and then dermofat was harvested after separating the epidermis from the dermis of the island skin completely using sharp Metzenbaum scissors. It could be 10 to 15 cm in the length and 4 to 7 cm in the width and this was modified for the need. This covered exposed carotid artery and was sutured with surrounding tissue. PMMC was introduced over the dermofat graft, which lasted at least more than one month that was sufficient for the infected neck wound to recover.