The lateral arm fasciocutaneous free flap based off the posterior collateral radial artery is advantageous for its color match to facial skin, relatively pliable tissue with adipose tissue resistant to ptosis over time, and minimal donor site morbidity. The flap can be used to reconstruct a variety of soft tissue defects, with the benefit of simultaneous harvest of the posterior cutaneous nerve to the forearm for nerve grafting. Modifications for larger skin paddles, neurotization of the flap, and even harvest of a segment of humerus or triceps tendon can be performed. While a versatile flap with reliable anatomy, the pedicle length and caliber of the lateral arm are limited compared to other fasciocutaneous flaps. Despite these limitations, the lateral arm free flap is a powerful flap for soft tissue reconstruction in the head and neck.