Background Lateral thoracic (LT) flaps are primarily used as pedicle flaps for reconstructing limb and chest wall defects and have rarely been applied for head and neck reconstruction.We aimed to present our surgical techniques and experience using free LT cutaneous,myocutaneous and conjoint flaps for oral and maxillofacial reconstruction.Methods From 2006to 2010,we reconstructed 28cases of oral and maxillofacial soft tissue defects using LT flaps.Controls were 54cases reconstructed with anterior forearm flaps during same period.Flap size and pedicle length were recorded intraoperatively.Patients were monitored for flap survival in hospital until discharge and then followed regularly for 3to 38months,assessing for tumor recurrence,flap appearance,donor site function and cosmesis.Results All patients had free flaps except for one LT pedicle flap.LT flap patients were significantly younger than controls (45.5vs.54.8years,p = 0.004) and had greater flap size than controls (55.2cm2vs.40.3cm2,p = 0.001).Of 28LT flaps transferred,26survived completely;1failed,1suffered tip necrosis and 1had total necrosis due to venous insufficiency.No significant differences were observed in flap survival between groups.Follow-up was shorter in LT flap patients than in controls (20.3months vs.26.9months,p = 0.02).Conclusion Application of the LT flap is a reliable technique for reconstruction of maxillofacial defects with minimal donor site morbidity and favorable aesthetic outcomes.Level of Evidence:Clinical question:Therapeutic.Level of evidence:ASPS Level Ⅲ.