The fibular free flap has become the workhorse flap for bony reconstruction of the head and neck since it was utilized by Hidalgo in 1989. The flap is pedicled on the peroneal artery and venae comitantes. A significant amount of thick bone stock (up to 25 cm) allows for the reconstruction of large bony defects including those of the mandible and midface. The bone can be harvested with or without a thin, pliable skin paddle supplied by septocutaneous perforators traveling within the posterior crural septum.