The gastro-omental flap is an infrequently used yet valuable tool in the modern reconstructive surgeon's armamentarium. It provides a smooth, thin, pliable mucosal flap for reconstruction of oral, oropharyngeal, and pharyngoesophageal defects, particularly those with large soft tissue loss. Stephen W. Bayles, MD, and Richard E. Hayden, MD, present a series of 25 patients with head and neck defects over a 19-year period in whom reconstruction with a gastro-omental flap was performed. The flap success rate was 96%, and only 1 flap developed venous thrombosis. Particular applications of this flap are discussed and illustrative cases presented.