While a number of flaps are available that can "plug the hole" created by the resection of an oral cavity malignancy, the final functional and cosmetic result is often far from satisfactory. The ideal flap for this area should provide a one-stage, reliable reconstruction (regardless of previous surgery or irradiation) with the options of thin pliable skin and/or vascularized bone. Donor-site morbidity must be acceptable. In our experience, the free radial forearm flap best approaches these ideals. Unfortunately, it has received relatively little attention in the otolaryngology literature. The results of using 15 of these flaps to reconstruct 14 oral cavity defects are reported here. Despite the fact that most of the reconstructions were performed in older patients who had undergone irradiation (nine of 14) and previous surgical treatment (ten of 14), there were no flap failures. Hospital stays were short (less than two weeks), cosmetic results were good, and all but one patient had resumed oral intake by the time of hospital discharge. The specific applications and limitations of this flap are emphasized so that the reader can better understand its role in head and neck reconstructive surgery.