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We have employed the serratus anterior muscle vascularized rib (SARIB) composite flap for a variety of multifaceted reconstructive applications in which bone and soft tissues were needed. Seventeen patients have undergone this procedure for reconstructions of the upper extremity (5), lower extremity reconstructions (4), and reconstruction of head and neck defects (8). Sixteen of the reconstructions (89%) have been successful, with an average follow-up over 2 years. One patient had partial loss of a rib transferred to the head and neck for palatal reconstruction. One patient had complete flap loss of a maxillectomy reconstruction owing to a necrotizing infection. We have found this procedure to be applicable to a number of clinical reconstructive situations and recommend the SARIB procedure as a versatile operation that is successful in a high percentage of cases.