ObjectiveWe aimed to remind surgeons of the presence of thethoracoacromial arterial trunk and cephalic vein (TATCV)for a comfortable and reliable free flap transferto the head, arm, and trunk, in case the mainstreamrecipient vessels of these regions pose some inconveniencesdue to previous surgery, radiotherapy, ortrauma.Material and MethodsEight cases of trauma or tumor involving the head andneck or upper extremity, treated with free tissue transferin which this vascular system was used with differentmodalities, were reviewed retrospectively.ResultsThis vascular system proved to be reliable in all cases.It enabled chimerization with the pectoral flap. It wasused in six patients for head and neck reconstructionsand in two upper extremity restrorations. Switchingthe anastomoses to TAT-CV site and cephalic veintransposition were found to be rapid and reliable methodsto rescue a flap with compromised circulation.DiscussionAlthough anatomically well known by many reconstructivesurgeons, its ease of dissection, consistency,supply of branches of differing caliber, and strategiclocation is not adequately appreciated. Moreover, incases of pectoralis major flap transfer in which additionaltissue is required, this vascular system is alreadythere to receive it.