Reconstruction of the mid-face and skull-base has benefited greatly from microsurgical techniques. Defects from radical cancer ablations can readily be reconstructed providing patients with one-stage functional and cosmetic satisfaction. Particularly with skull-base surgery, the need to separate exposed brain from the contaminated oral and nasal cavities is paramount. The free rectus abdominus myofascial or myocutaneous flap has rapidly become the workhorse for these reconstructions. The bulk of the flap allows for wide separation of intracranial contents from oral and nasal contaminants. Enough tissue is available to adequately reconstruct the palate, midface, orbit, and skull-base. We have developed several modifications to improve both the function and cosmesis of these reconstructions. Dissatisfaction with the appearance of the abdominal skin on the face has lead us to use large cervicofacial rotation flaps to cover the rectus muscle, when skin of the midface is removed. If this cannot be accomplished, simple skin-grafting of the muscle is used. Furthermore, we no longer use abdominal skin intra-orally. Instead, fascia or muscle itself is sutured to oral mucosa, and then allowed to secondarily mucosalize. Lastly, the flap is suspended from the skull base defect using non-absorbable suture tacked to bone-anchored screws. This prevents downward gravitational pull on the flap, decreasing the risk of CSF leak or pneumocephalus. In this paper we review other techniques for mid-face and skull-base reconstruction, and present our modifications and results.