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Background  Surgical management in laryngeal carcinoma remains a challenge with countless unexpected complications. Great vessel anomalies such as anomaly of the innominate artery carry high risk of morbidity and mortality if not managed properly.    Methods  We present our first experience with an aberrant innominate artery during total laryngectomy which complicated the whole surgical procedure and tracheostoma placement.    Results  We decided to place a pectoralis major muscle flap to separate and cover up the aberrant vessel from the trachea and end‐stoma which ultimately did not lead to major complications postoperatively and postradiation therapy.    Conclusion  Aberrant innominate artery is an extremely rare entity and failure of recognizance can lead to hazardous complications. Preoperative angiography needs to be done if there are high suspicions of aberrant vessels in the operative field. Careful dissection of the head and neck region, and prompt decision making are mandatory to manage such cases.    Levels of Evidence  Case Report

Aberrant innominate artery: A possible hazard during total laryngectomy