Background: Psoriasis is a chronic immune-mediated inflammatory condition, affecting 2-4% of the population, characterized by salmon-pink plaques with silvery-white scales. Surgical intervention on psoriatic skin has relative contraindications, including Koebnerization —a phenomenon wherein new psoriasis-like lesions emerge at the sites of skin injury—and postoperative infections due to elevated bacterial counts, often Staphylococcus aureus and Staphylococcus epidermidis. Case: A 52-year-old male required free tissue transfer reconstruction after oral cavity carcinoma resection. He had poorly managed psoriasis covering 70% of his body. Dermatology optimized psoriasis management. Severe psoriasis was on his thighs, milder on forearms. Despite psoriasis-related contraindications, he underwent hemiglossectomy and radial forearm free flap reconstruction. No intraoral psoriasis flare-ups, infections, or Koebner phenomena occurred immediately or within three months. Discussion: This case highlights challenges in reconstructive surgery with psoriasis and the need for research on psoriasis's impact on donor tissues. Only one documented case used a free forearm flap for oral cavity reconstruction from a psoriatic donor site. Our approach differed by choosing mild-symptom donor tissue and involving dermatology. Notably, our patient's donor tissue showed complete psoriasis resolution, promising further investigation.