In an irradiated and vessel depleted neck, we used the wrist carrier technique to provide flap perfusion until autonomisation took place. A combined anterolateral thigh- and osteocutaneous fibular flap was anastomosed to the radial vessels of an irradiated patient with a vessel depleted neck for reconstruction of the lower face. Periodical pedicle occlusion started immediately after surgery. On day 16, cutaneous blood flow and oxygenation were still reduced, but wound healing was uneventful.