The osteocutaneous radial forearm free flap (OCRFFF) is a variation of the more commonly used radial forearm free flap (RFFF) that involves harvesting partial thickness of the radius just proximal to the radial flare in addition to a skin paddle. The radial forearm free flap was first used and described by Dr. Yang and Dr. Gao at the Shenyang Military Hospital in 1978 [21]. This led to the rise of the use of the OCRFFF in the early 1980s followed by its decline in use in the late 1980s due to significant donor site morbidities, primarily fracture of the forearm [13, 15, 16]. It has been described in its reconstruction of midface [1] and mandibular defects [2], but also of foot and ankle reconstruction and lower extremity defects [4], hand reconstruction [20], and phalloplasty [8]. Historically, its use has been limited due to the concern for radius fracture, but this risk has become a rare event with the implementation of prophylactic plating of the radius [18]. Alternatives to its use in midface and mandibular reconstruction include the osteocutaneous iliac crest, scapular, and fibular free flaps.