A composite free flap with the lower part of the scapula and the serratus muscle has been used in two clinical cases for reconstruction after extensive maxillectomy and craniofacial resection. The palatal defect was reconstructed with the lower part of the scapular bone and the bone and the serratus muscle was used to restore facial contour. This type of osteomuscular free flap based on the thoracodorsal artery and veins provides a one-stage reconstruction of complex facial defects, including bone and soft tissue. The main advantages of this flap are the configuration of its bony component that closely matches the hard palate and its versatility that allows other regional flaps such as the latissimus dorsi and/or the serratus to be raised on the same vascular pedicle.