The thoracodorsal artery perforator flap is a versatile flap for the reconstruction of various soft tissue defects. Several anatomical variations of thoracodorsal artery have been described and an “accessory thoracodorsal artery” which has a separate and direct origin from the axillary artery has been reported. In this report, we describe a very unusual direct cutaneous perforator, which ran in a subfascial course above the latissimus dorsi muscle and was found to originate directly from the axillary artery. Based on these findings, surgeons should be aware of the possible existence of this unusual anatomical variation during surgery to avoid missing this perforator. Clin. Anat. 26:1024–1027, 2013. © 2012 Wiley Periodicals, Inc.