The elbow joint, essential for daily activities, often requires soft tissue reconstruction following trauma, infection, or tumor excision. Free flap surgery using the brachial artery (BA) as the recipient vessel offers stable vascular support, but preserving distal blood flow is crucial. Due to vessel diameter differences, end-to-side (ETS) anastomosis is usually necessary, as flow-through anastomosis can be challenging. Although reports exist on soft tissue reconstruction using the BA as the recipient vessel, complications and outcomes related to using the sole main artery as the recipient remain unclear. We developed the microscopic parachute end-to-side (MPETS) technique, adapted from ETS, to more easily address vessel size discrepancies. This study evaluates the effectiveness and safety of MPETS in BA-based elbow reconstruction, alongside a review of outcomes in other cases. We retrospectively analyzed seven cases of elbow reconstruction from April 2018 to September 2023, focusing on patients with BA recipient vessels and a minimum 12-month follow-up. Variables included patient demographics, etiologies, flap types, and postoperative outcomes measured by Jupiter's Criteria. Following PRISMA 2020 guidelines, a systematic literature review identified similar cases using the BA in free flap reconstruction for comparison. In all our cases, flap survival was 100%, with no distal ischemia observed, and the average range of motion was 119°. Complications were limited, with one reoperation due to venous thrombosis. The MPETS technique minimized blood flow issues and accommodated the BA's diameter. The literature review included 77 cases, confirming the BA's viability and stability as a recipient vessel. Using the BA as a recipient vessel with MPETS demonstrates high effectiveness and safety in elbow soft tissue reconstruction. Our results support the BA's suitability for complex reconstructions, with MPETS enhancing vessel compatibility and reducing complications.