A pedicled thoracoumbilical flap was evaluated in 5 patients for upper limb reconstruction. The flap appears to be a reliable axial flap that can be elevated safely to the midaxillary line. It has the capacity to transfer a large amount of tissue, allowing the damaged limb, during the attached period, to be elevated and to receive physiotherapy. Although the working portion of the flap uses the thin, hairless skin over the lateral ribs, the base of the flap is thick and difficult to tube in all but the thinnest of individuals. The donor scar is much more conspicious than that of a groin flap.