The pectoralis minor myocutaneous, osteomyocutaneous, and osteomuscular flaps were used in 14 patients. Thirteen cases had mandibular replacement, with bilateral flap application in three. The first eight flaps incorporated the fifth rib and the last eight flaps included the sixth rib. In the last four cases, the flap was transferred through a subclavicular tunnel. A mentum defect was present in 11 patients. There was one total flap necrosis due to venous thrombosis caused by surgical trauma. The flap provides rich vascularization and versatility, requires a small volume, and does not present serious sequelae to the donor site. It may be performed by a two-team approach and is a valid option for head and neck reconstruction.