The extended temporoparietal fascia flap is a logical variation of previously accepted extended free tissue transfers, which are unique in that the recipient and donor vessels are identical. This local scalp flap permits adequate distant ipsilateral skull coverage with minimal patient inconvenience. If desired, retrograde fascial perfusion from cephalad collaterals allows the completion of long interposition vein graft microanastomosis to the superficial temporal vessels before creating any recipient site defect without fear of flap warm ischemia time. Although the patient described had complications, the concept of the extended temporoparietal fascia flap has been proved to be an intriguing option for head and neck reconstruction.