THREE times a year on average, we are called upon to treat patients with gunshot injuries to the mid and lower face which involve loss of much facial soft tissue, intra-oral lining and intervening bone; in addition, there are often cornminuted fractures of the bones adjacent to the open wound. Primary treatment has usually consisted only of debridement, stabilisation of the fractures and perhaps dressing the wounds with skin grafts. Later the oral lining and the skin defect have been reconstructed with local tissues and/or skin flaps. Still later, efforts have been made to reconstruct the missing skeleton with bone grafts but exposure of the remaining facial skeleton is difficult and the graft bed is often fibrotic. Although many of these patients have had 30 to 35 operations, the results are disappointing. In searching for a better solution to the problem we considered the case of a sculptor patching a damaged clay model. First he would build an armature into the damaged area and upon this replace the missing clay. Finally a glaze would be applied to protect the reconstruction. By analogy, in a complex facial reconstruction, the armature could be bone grafts to simulate the facial skeleton, the clay could be the vascular omentum and the outer protective layer could be a skin graft. In the rather meagre literature on reconstruction of the maxilla, there is one article of note. Obwegeser (1973) describes an ingenious reconstruction of the maxilla using a lattice of split rib grafts fixed to the remaining stable points. The bone bending forceps of Tessier are essential to bend the ribs to the proper cont0ur.l During the past 3 years, we have used the omentum as a pedicled flap for chest wall reconstruction in 12 patients with radiation necrosis (Jurkiewicz, 1977x as pioneered by Kiricuta (1963) and DuPont and Menard (1972). We had no significant complications and were impressed with the ease with which skin grafts took upon the omentum. More recently, our colleague, Dr P. G. Arnold (Arnold et al., 1976) impressed us with the use of the omentum as a “vascular putty” to cover a Silastic gel prosthesis in reconstructing a breast; even though the reconstruction was covered with a skin graft, the contour of the reconstructed breast more nearly corresponded to that of the normal breast than any other reconstruction we have seen. Alday and Goldsmith (1972) and Das (1976) have defined the vascular anatomy of the omentum and its variations. There are usually 3 main omental vessels which arise from the gastro-epiploic arcade. In 1972, McLean and Buncke first reported the free transfer of the omentum by microvascular anastomosis to repair a scalp defect. The gastro-epiploic vessels are 1.5 to 3.0 mm in diameter and their anastomosis to similar sized vessels is relatively easy. Friendly collaboration and support from surgical colleagues, operating room staff and anaesthetist is essential; in the case to be described the anaesthetic time was 144 hours !