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In neoadjuvant intra-arterial infusion chemotherapy patients, the common recipient arteries are frequently damaged owing to preoperative chemotherapy-induced intima injury. When ante-grade arterial inflow to the free flap is not available, end-to-side carotid arterial anastomosis or exploration of another recipient artery may be an appropriate solution. However, reversed arterial flow is an alternative to such a situation. We report a case with squamous cell carcinoma on the right buccal area, which was successfully reconstructed using a free anterolateral thigh flap with reverse superior thyroid arterial inflow. This alternative method might shorten the operation time and also reduce further exploration injury in the operation field.