In head and neck surgery, the internal jugular vein has been the most reliable and one of the most frequently used recipient vessels. Recently, thrombosis of the vein has become a problem in head and neck microsurgical reconstruction. We report our experience of using cephalic vein transposition in seven patients with unavailable local veins for free flap anastomosis. Venous thrombosis after primary free flap reconstruction, or secondary microsurgical reconstruction was a reliable treatment option. A long pedicle can be taken to reach the mid-face. In patients with enucleated eyeball, without undue tension, coverage with a free flap was successfully achieved. At the chest wall besides the neck area, the cephalic vein can serve as a useful resource to save the venous depletion in cases of thoracic esophageal reconstruction with pedicled colon adding supercharge and superdrainage. The cephalic vein provided reliable and adequate flow for the free flap. The cephalic vein is located outside the ablative surgical or radiated field, and it was undamaged. As a last resource, using the cephalic vein should be considered at critical situation in head and neck reconstruction.