The pectoralis major myocutaneous flap (PMMF) remains a useful flap for head and neck reconstruction. Although free-tissue transfer is often preferred, the benefits of the PMMF should not be overlooked. A retrospective chart review was performed on all PMMFs used at Emory for head and neck reconstruction from 1992 through 2008. A total of 139 PMMF were performed in 136 patients with an average age of 65 years. Eighty-six patients were males. All patients except one had a history of Head and Neck Cancer. A smoking history was present in 92% of the patients. Defect location included oral cavity (n = 59), pharyngeal/fistulae (n = 48), temporal bone and cheek (n = 24), oropharyngeal (n = 4), and esophageal (n = 2). The PMMF was used in 4 occasions as a salvage procedure. The survival of the flap was 99.2% (138/139). The PMMF provided definitive closure of the defect in 100% of the cases. The overall average follow-up was 10.5 months. Eighteen patients (13%) developed complications after the procedure. Patients who had radiation therapy had significantly higher complication rates. The PMMF flap remains a very versatile technique with proven reliability for soft tissue coverage of many head and neck defects.