Objective: To analyze the value and reliability of combined free fibula flap and radial forearm flap in the reconstruction of extensive composite oro-mandibular defects. Methods: Extensive composite oro-mandibular defects were reconstructed in 23 consecutive cases (averagely aged 52.9 years old) with combined free fibula flap and radial forearm flap from March 2000 to January 2002. Data concerning the operation, defect description and site, recipient vessel and complications were reviewed. Results: The overall flap survival rate was 100% (all of 46 flaps) without partial or total flap necrosis. The overall complication rate was 30.4%. The vessel thrombosis rate was 2.2%, and the flap salvage rate was 100%. Conclusion: In selected cases, combined free fibula flap and radial forearm flap method may provide satisfactory reconstruction for extensive oro-mandibular defect, and greatly improve the quality of life of patients.