BACKGROUND: Reoperative free tissue transfer in head and neck cancer patients may be extremely difficult secondary to extensive scar and radiation injury leading to lack of recipient vessels. The thoracoacromial artery and its venae comitantes are alternative vessels that may be used in this situation. METHODS: Between 1997 and 2005, 16 patients underwent free tissue transfer for head and neck reconstruction performed using the thoracoacromial vessels for microanastomosis in 17 flaps. Thirteen flaps were performed in 12 patients who had been irradiated twice. Twelve thoracoacromial trunks used as recipient vessels were in patients with transferred pectoral myofascial flaps. RESULTS: Anastomotic patency was achieved in all flaps. Previous pectoral myofascial flaps made anastomosis to the thoracoacromial vessels easier to perform. CONCLUSION: The thoracoacromial trunk is a good source of access for recipient vessels in reoperative reconstructive microsurgery of the head and neck and anastomosis was able to be performed in patients with previously transferred and irradiated pectoralis major myofascial flaps with equal success.