Reconstruction of major defects in the head and neck is usually an area where maxillofacial or plastic surgery colleagues come to assist, with consideration of the size and function any repair has to fulfil. Whilst the radial forearm free flap (RFFF) is well known and tested, this group of surgeons from Sunderland, UK, discuss their experience with a comparable flap. They advocate the medial sural artery perforator flap (MSAPF), with a long pedicle if required and donor site primary closure as advantages over the RFFF. It also has the lack of bulk that is sometimes desired in a reconstruction. They speculate that its lack of popularity may be to do with concerns over poor perforating vessels, which was not the case in their series of six. Perhaps we will be hearing more of this free flap in oncology MDTs up and down the country in the near future.