Abstract Over the past four years twenty-one immediate mandibular reconstructions after a commando type resection for squamous cell carcinoma of the oral cavity involving the mandible have been accomplished by a two team approach. The mandibular arch is reconstructed by an autogenous bone graft and covered with a lining flap consisting of the entire forehead and based on the unilateral superficial temporal and posterior auricular vessels. Two patients have died of the original disease, one from residual and one from metastatic cancer. Seven bone grafts have been lost, three from partial flap necrosis, two from infection from leakage after separation during delirium tremens attacks, and two from gradual absorption secondary to leakage and infection. Refinements in technic have been outlined to reduce complications and insure a functional and cosmetic final result.