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Objective To describe the natural history of bone segment union in head and neck free flap procedures and detail the association of poor segment union with postoperative complications. Study design Case series with chart review. Setting Single tertiary care referral center. Subjects and method Patients with mandibular or maxillary defects reconstructed with osseous or osteocutaneous free flaps were analyzed (n = 104). Postoperative computed tomography or positron emission tomography/computed tomography scans were reviewed for signs of os