Background: The free posterior tibial artery flap (PTAF) is a fasciocutaneous flap whose skin paddle is based off the distal perforators of the posterior tibial artery. Like the radial forearm free flap (RFFF) in terms of pedicle length and pliability, the PTAF yields a thicker flap, can be chimeric due to its perforators, and is more easily concealed. Learning Objectives: Participants should understand patient selection, anatomy, and PTAF harvest technique. Study Objective: Assess applicability of PTAF for head and neck reconstruction. Design Type: Retrospective review of patients undergoing PTAF for defects of the head and neck with discussion of technique and anatomy. Methods: Patient demographics, defect type, outcomes were collected. Results: Five patients with defects including two hypopharyngeal defects, orbital exenteration, tongue/floor of mouth, and oropharynx were reconstructed using the PTAF. All but one had previously been radiated. All flaps survived. Three vessel runoff was assessed by computed tomographic angiography or arterial duplex Doppler. Donor sites were reconstructed with a split or full thickness skin graft from the flap itself. Patients were able to ambulate postoperative day 1. One patient developed a late pharyngocutaneous fistula repaired with local tissue rearrangement. One patient required secondary skin grafting to her donor site for partial skin graft loss. The donor site was easily concealed by a calf-length sock. Conclusions: The PTAF provides an excellent fasciocutaneous option for reconstruction of the head and neck. With its thicker subcutaneous layer and long pedicle, the PTAF is a versatile flap for head and neck reconstruction.