Objective Laryngeal contact granuloma (LCG) is a kind of benign lesion that related with improper use of voice, habitual throat clearing and laryngopharyngeal reflux. Under 3 months standardized treatment, those who have no improvement or disease recurrence are called refractory LCG. The purpose of this study was to explore an advanced surgical method with local flipped pedicle microflap combined with botulinum toxin A injection in the treatment of refractory LCG. Design A retrospectively analysed of totally 11 patients with refractory LCG from January 2018 to December 2020. After CO2 laser granuloma resection with local flipped pedicle microflap combined with botulinum toxin A injection, the patients were followed up at 1, 3, 6 and 12 months after operation to evaluate the effect of the surgery. Descriptive statistical methods were used to analyze and summarize the improvement of postoperative symptoms and signs of laryngoscope. Results During follow-up, 4 of 11 patients had residual pseudomembrane under the electronic laryngoscope, and had smooth mucosa when subsequent follow-up. The remaining 7 cases of electronic laryngoscope granuloma disappeared. Up to now their symptoms disappeared, and there were no systemic and local complications. Conclusion CO2 laser granuloma resection with local flipped pedicle microflap combined with botulinum toxin A injection can achieve the lesion clearance, restore the integrity of vocal fold cover-body, preserve the perichondrium, and reserve a time window for microflap recovery. It is based on the principle of preserving normal mucosa, with high cure rate and no recurrence. It is worthy of clinical promotion.