Background: Innervated musculocutaneous flaps are often utilised in trauma reconstruction settings. Motor-innervated free or pedicled tissue-transfer following extremity soft tissue sarcoma (ESTS) resection occurs less frequently. Case: A retired right-handed 74 male presented with biopsy-proven left biceps-brachii high-grade pleomorphic sarcomatoid malignancy. MRI demonstrated a 63x31mm lobulated mass interposed between biceps and brachialis, entrapping the musculocutaneous nerve (MCN). Median nerve and brachial artery and basilic vein were spared. Functional reconstruction was planned with a pedicled LD flap. Intraoperative resection revealed a defect comprising 14cm of biceps brachii muscle belly, deltoid insertion and origin of brachialis. 13cm of MCN was also transected proximally. Distal MCN segment into brachialis was then identified and demonstrated stimulated fascicular activity. Viable proximal and distal stumps of MCN warranted intraoperative utilisation of LCNF as a cable graft, with neurolysis, veraseal and microsurgical repair. The pedicled, functional LD was inset as originally planned. The patient reports excellent 6-month postoperative functional outcome. He has no functional limitation and has unlimited left elbow flexion and extension and shoulder abduction to 75 degrees. He moves his left hand to mouth and head with ease. Conclusions: Intraoperative availability of viable MCN stumps facilitated enhanced functional reconstruction with free LCNF grafting to ameliorate elbow flexion. Our patient demonstrates favourable outcomes from what would have been an otherwise functionally-limiting resection. We encourage an adaptable, adjustable and opportunistic approach to functional reconstruction, particularly in variable ESTS resection. This versatility may confer significant improvement patient outcomes and mitigate associated morbidity.