58-year-old patient with a history of venous thrombosis in MMII. Rest of the patient was of no interest. She presented with an ulcerated lesion at the level of the left jugal mucosa, approximately 3 cm in diameter, compatible with squamous cell carcinoma. A 2 cm diameter lymphadenopathy was also palpable at cervical level I.

Surgery was performed and the tumour lesion was resected with a safety margin and unilateral functional cervical dissection. The defect was reconstructed using a medial brachial graft from the left arm.

The pedicle of the flap was taken from the ACCS, which was anastomosed with the facial artery, and the thyrolinguinguofacial venous trunk (TVTLF), which was joined to one of the concomitant veins of the ACCS, as no blood refluxed through the basilic vein. The length of the pedicle was about 6 cm, the diameter of the artery 1.5 mm and the diameter of the vein 1 mm.

The intraoral defect was completely covered, providing sufficient volume, and the arm skin closure was performed directly without the need for a free graft.

The patient was discharged 10 days after the operation and the graft was found to be viable.