Background: Reconstruction of head and neck defects can be challenging due to the complexity of the defect caused by tumor ablation and radiation therapy. The latter produces a vessel-depleted, ischemic tissue bed, increasing the likelihood of flap failure. Flow-through free flaps have been used in head and neck reconstruction since the 1980s, providing an arterial source for an additional flap to cover a large defect while also providing soft tissue coverage.

Case Report: We present the case of a 50-year-old male with an anterior neck defect measuring approximately 15 by 25 cm after excision of oral squamous cell carcinoma followed by radiation therapy.

Intervention: Reconstruction of the defect was done using an ALT flow-through free flap plus a radial forearm free flap.

Outcome: The patient was able to speak coherently after surgery, but he developed flap dehiscence, which was treated with dressings, as well as acute kidney injury.