The ability to bring distant well vascularized tissue to the head and neck has created new reconstructive options following surgical ablation for malignancy. Although the initial operative time is increased, microvascular free tissue transfer reconstruction often yields a superior result without the need for multiple staged operations. A multitude of donor sites have been developed, each with an advantage for reconstruction. Free tissue transfers are especially indicated when local tissue is deficient, of a poor quality or where a highly vascular flap is needed.