Total cheek defects in twenty cases of carcinoma of the buccal mucosa undergoing ablative surgery were reconstructed. A pectoralis major myocutaneous flap (alone or in combination with another flap) and cervicofacial flap were the most common methods used (ten and eight cases respectively). It was found that neck dissection, bony resection and pre- operative irradiation did not influence the choice of flaps. Patients gender and local soft tissue topography were the most important determinants in flap selection.