The authors present a new application of the procedure they called the "reverse flow YV pedicle extension" which allows a very distal pedicled mobilisation of the lateral arm flap. Until now, only the distally based lateral arm flap and the ulnar recurrent fascicutaneous island flap could to be transferred distally but reached only the proximal third of the forearm. In our experience these flaps did not seem to be very reliable. Lengthening of the lateral arm flap pedicle using the lateral triceps artery (branch arising from the profunda brachii artery) allows the lateral arm flap to be transferred beyond the distal third of the forearm. This so-called "extreme" lateral arm flap has advantages and disadvantages which are discussed in this paper. We consider cutaneous or osteocutaneous reconstructions of the forearm to be the best indication for this flap. Our first clinical case is reported.