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Head and neck cancer often requires multiple defect reconstruction that are too far apart to handle with 1 flap. However, 1 flap with skin graft, or multiple flap reconstruction is always not possible due to recipient site factors and lack of sufficient donor site. In this report, we share our experience on reconstruction of multiple, and distant head and neck defects with 1 large radial forearm flap that was vertically inset to cover multiple defect on face, and then tunneled to reach down to the neck. Due to the longer dimension, this flap could be utilized not only to reconstruct the face and neck area, but also simultaneously reconstruct face and orbit, or face and scalp area. We think that this modification of the radial forearm flap could provide a useful surgical option for multiple and distant head and neck reconstructions.