The addition of a pleural segment to the osteomyocutaneous flap used in head and neck reconstruction can be efficacious in selected cases. The pleura underlying the rib segment has been shown to remain viable and provide good healing and oral lining. The extent of pleura that can be transferred is unknown and currently being investigated, but pleura can be safely taken to the edges of the superior and inferior ribs. The pleura offers a thin, pliable, reconstructed surface to the oral cavity that alleviates bulky flaps or difficulty with intraoral skin grafts. This adaptation is a valuable addition to the surgeon in head and neck reconstruction.