Microsurgical transplant has the additional advantage over bone graft of being a composite tissue, resembling the defect it is intended to replace. This applies particularly to the mandible, as the mucocutaneous tissues are intimately applied over the bone. Regardless of the ingenuity of the transplant design and the different variations, none of the flaps used in this series of 37 microsurgical reconstructions was able to validly reconstruct bone and/or mucosa and/or skin in a single operative stage. It very rapidly became apparent that microsurgical reconstruction of the mandible needs to be divided into several stages in order to taken into account the mucosal defect. This choice of a more difficult alternative based on the lack of bone donor sites is compensated by the good tolerance of intestinal transfers to the buccal cavity.