Thoracoacromial artery perforator flaps are not commonly used in clinical practice. Most existing reports describe the use of thoracoacromial artery perforators as pedicled or islanded flaps for local reconstruction [1]. Additionally, advancements in ultrasonography have enhanced its utility in plastic surgery, especially for pre-operative planning in reconstructive surgeries [2]. This report presents a case that utilised pre-operative ultrasonography to plan for a thoracoacromial artery perforator free flap that was successfully used to reconstruct a right temple defect in a 64 year-old male with a rapidly growing squamous cell carcinoma. This flap is thin and pliable, providing robust soft tissue coverage whilst allowing for subtle contouring and a good colour and texture match cosmetically. Its preservation of the pectoralis major muscle minimises contour defects and functional impairments at the donor site, which is often able to be directly closed. Thus, the thoracoacromial artery perforator free flap is an under-used yet versatile flap for head and neck reconstruction. Concerns regarding inconsistent perforators could be overcome using ultrasonography, ensuring the best option is selected on an individualised basis without increasing radiation or costs for patients. 1.Zhang YX, Yongjie H, Messmer C, Ong YS, Li Z, Zhou X, et al. Thoracoacromial artery perforator flap: anatomical basis and clinical applications. Plast Reconstr Surg. 2013; 131(5), 759e–770e. 2.Cowan R, Mann G, Salibian AA. Ultrasound in microsurgery: current applications and new frontiers. J Clin Med. 2024; 13(12), 3412.