Extensive free/pedicled musculocutaneous flaps are essential pre-requisites for reconstruction in the breast, axillary, head and neck region. Such surgeries also require adequate or additional vascular supply at the recipient site. The segmental anatomy and neurovascular supply of the pectoral is major muscle aptly makes it the most favoured source of grafts, with a reliable source of vascular supply available from the adjoining thoraco-acromial arterial axis and cephalic vein. We report a case wherein the clavicular origin of pectoral is major muscle was pierced by the cephalic vein. The thoraco-acromial artery had a variant branching pattern with a peculiar presentation of the delto-pectoral groove and its contents. As facial and breast reconstruction surgeries rely on the availability and dependability of the aforementioned anatomical structures, any atypical presentations may cause intra-operative confusion and hinder the success of reconstructive procedures.
Cephalic vein, Musculocutaneous flaps, Pectoral is major, Thoraco-acromial artery.