For extensive defects with loss of oral cavity mucosa, mandibular continuity, as well as skin, a number of reconstructive options have been used including single flap reconstructions based on “mega” flaps like the scapular vessel system. While the fibular free flap provides excellent bone for mandibular reconstruction, concerns have been raised regarding the viability of the skin paddle and its reliability. Most authors advocate against the harvest of skin paddles large enough to allow for simultaneous management of intraoral as well as cutaneous defects. We report here a series of 18 patients with large complicated through and through defects of the oral cavity and facial skin who have been successfully reconstructed with a singular fibular free flap utilizing a large skin paddle. De-epthelialization of the center of the paddle and creation of a “bilobed” flap allows for closure of mucosal and skin defects concurrently. Surgical defects in this study were all composed of full thickness defects encompassing a mucosal, bone, and skin component. Five patients had isolated anterior bony defects with concurrent lip defects. The remainder of the patients had extension of soft tissue defects into the lateral cheek/buccal mucosal regions. Flaps were harvested with skin paddles ranging in size from 12cm x 9cm to 29cm x 19 cm. The skin paddles were de-epithelialized in their central region to allow for accommodation and folding required for appropriate insetting. All patients were successfully reconstructed in this study. Follow up of patients ranged from 1 to 41 months. No deaths occurred in the immediate peri-operative period. There were no flap failures skin paddle survival in all patients. 7 of 18 patients were able to progress to oral diets. One major flap related complications occurred with non-take of the split thickness skin graft to his donor site requiring regrafting. In 6/18 patients minor flap complications occurred. Three patients had small areas of non-take of the split thickness skin graft which were treated conservatively with local debridement. The remaining three had minimal skin loss (<10%). Three patients underwent secondary lip commisuroplasties, and one had minor soft tissue debulking. In summary, we feel that, in contrast to previously reported literature, the fibula osteomyocutaneous free flap can provide a safe and reliable large skin paddle allowing bilobed reconstruction of complicated through and through head and neck defects.