The radial forearm flap has proven to be a very reliable and versatile technique for reconstructing head and neck defects. It is of particular value where segmental defects in the mandible and intraoral mucosa exist, and in reconstructing defects within radiated tissue. The skin of the flap drapes well over the radial bone to allow denture fitting. The radial bone provides an adequate bony strut to allow essentially normal mandibular function. In a previously radiated bed, the flap (from a non-irradiated area) has the virtue of being highly vascular, thus benefiting wound healing. The lack of bulk in the flap prevents separation at the site of inset as wound healing occurs. It is a one-stage reconstruction, and since the donor site is on the upper extremity, early patient mobilization is possible. The donor defect is cosmetically acceptable, and since it lies against the body in the position of rest, it is not frequently exposed. The osseous portion of the flap in a postmenopausal woman should be approached with caution and patients should be warned of the risk of radius fracture. This flap is capable of providing tissue for reconstruction of the head and neck and should be considered for closure of all major defects, particularly those with bone defects or in defects created postirradiation.