Donor site necrosis is a very rare complication of palatal rotational flaps. The aim of this case report is to present a 43-year-old female, Type I diabetic patient with a chronic oroantral fistula in the right second molar region. The patient had bony necrosis in the donor site following palatal rotational flap operation. The treatment approach and the alternative methods are discussed. (C) 2005 Elsevier Inc. All rights reserved.