Flap failure is mostly caused by venous thrombosis of the anastomosis. The failure rate is higher in post-irradiated neck. To reduce the risk of venous thrombosis, the authors propose to harvest the radial forearm flap using the cephalic vein as the drainage vein and as a pedicle. Only a single arterial anastomosis is carried out. This technique has been described already in patients who underwent head and neck ablative surgery with radical neck dissection. The authors report 2 cases in patients with post-irradiated neck. The flap transfers were successful in the 2 cases. The operative time of harvesting this hybrid version is the same with the conventional free flap technique. This version of the radial forearm flap can be a method of choice for some complex microvascular reconstruction in the head and neck region.