The thoracodorsal artery perforator flap is an evolved form of the latissimus dorsi free flap. Arterial supply is based on a distinct perforator(s) originating from the thoracodorsal artery and vein. The perforator anatomy is variable, but consistent landmarks and measurements have provided guidance to reliable harvest of this flap. Advantages of this flap is that it provides a pliable, relatively thin fasciocutaneous flap that spares latissimus dorsi function. The pedicle is long and of favorable caliber for nearly all head and neck defects.