Introduction: The transverse cervical vessels (TCVs) have been described as alternate recipient vessels in head and neck reconstructions when conventional options are unavailable. The literature, however, contains little clinical information describing their use. The purpose of this study was to describe the anatomic characteristics of the TCVs and summarize our clinical experience with their use. Methods: Vessel characteristics and landmarks were measured in 72 cadaver neck sides. Clinically, all microsurgical reconstructions using the TCVs over a ten year period at our center were reviewed. Results: The transverse cervical artery (TCA) was present in 100 percent of the dissections, and the vein (TCvn) in 85 percent. Usable pedicle length was between 4-7cm with an average diameter of 2.65mm (TCA) and 2.9mm (TCvn). Anatomic landmarks to facilitate exposure were identified. Lumenal disease was significantly less in the TCA specimens compared to external carotid specimens. Clinically, the TCVs were utilized in seventeen reconstructions (7 percent of cases). All patients had prior surgery and radiotherapy. No vein grafts were utilized and there were no flap failures. Conclusion: The TCAs are reliably present, readily located, and possess anatomic characteristics that render them a useful alternate recipient vessel option in difficult head and neck microsurgical reconstructions.