One of the great challenges in head and neck reconstruction in patients with recurrent cancer is the availability of recipient vessels. The neck is usually severely scarred from previous surgery and/or radiotherapy, making the carotid system a poor candidate. Going to the internal mammary or subclavian vessels would significantly increase the complexity of reconstruction. The transverse cervical vessels have rarely been described in the literature and are unfamiliar to many reconstructive surgeons. In order to investigate the suitability of transverse cervical vessels as recipient vessels, they were explored in 17 patients with recurrent head and neck cancer at The M. D. Anderson Cancer Center since August 2001. Their availability, location and size were documented. A total of 24 sides of necks were explored. The transverse cervical artery was found to be removed at the present surgery in two sides (8%). The artery had a diameter of less than 1.5 mm in six sides (25%), a diameter between 1.5 mm and 2.5 mm in 12 sides (50%), and a diameter greater than 2.5 mm (2.6 to 3 mm) in four sides (17%). The transverse cervical vein was removed in two sides (8%) and was non-existent upon exploration in one side (4%). The vein had a diameter of less than 1.5 mm in four sides (17%), a diameter between 1.5 mm and 2.5 mm in four sides (17%), and a diameter greater than 2.5 mm (3 to 5 mm) in 13 sides (54%). The transverse cervical vessels are usually located 1 to 2 cm above the clavicle and lateral to the sternocleidomastoid muscle. The exploration usually took less than 15 minutes. The supraclavicular area was found to be without scarring in all but one patient, while the anterior neck had significant scarring in all patients with previous surgery and/or radiotherapy. A vessel smaller than 1.5 mm was considered unsuitable and therefore was not used. No suitable vessels were found in either side of the neck in two patients (12). In five patients (29%), the transverse cervical vessels on one side were unsuitable, and the contralateral side was used. No flap complications occurred. In conclusion, suitable transverse cervical vessels were available in the majority of patients (88%) who had undergone previous surgery and/or radiotherapy. The supraclavicular area is usually unaffected by prior treatment. The use of transverse cervical vessels may avoid difficult dissection of the carotid system and prevent carotid artery rupture.