Hemorrhage from a carotido-cutaneous fistula after tumor resection may be difficult to arrest, especially if occlusion of the carotid artery produces neurological symptoms. A posterior deviation of the classical incision allows an approach to the carotid artery while local digital compression controls external hemorrhage. The fistulous tract can then be resected and the carotid axis restored with a graft via this approach. Perfusion of the brain is maintained during repair by an indwelling shunt. The details of this approach are presented.