Background: Free tissue transfer using microsurgical vascular anastomosis has added much to the ability of the 
reconstructive surgeon specially when dealing with a defect in the head and neck region. This study was conducted to assess the role of free flap transfer in restoration of tissue defects resulting from wide extirpation of advanced head and neck malignancies. 
Patients and Methods: The present study was conducted on 14 patients with proved head and neck cancers and who had surgical ablation of their cancers with reconstruction of the resulting defect with a free flap in a one-stage-operation. The flaps utilized included the free radial forearm flap (n=7), free scapular flap (n=5) and the free transverse rectus abdominis Myocutaneous (TRAM) flap (n=2). 
Results: There were eight men and six women. Their ages ranged from 35 to 67 years with a mean of. 47.67±2.3 years. Eleven patients had squamous cell carcinomas of their floor of mouth tongue, cheek, palate, and temple. The remaining patients had adenoid cystic carcinoma of parotid, recurrent basisquamous carcinoma of scalp and rhabdomyosarcoma of masseter muscle (one patient each). Thirteen flaps survived (92.9%) with good functional result. There was no operative mortality. Two patients had an orocutaneous fistula (14.29%). One patient died at 4 months postoperatively from local recurrence (7.14%). 
Conclusions: Free flap transfer is an essential tool in the field of head and neck cancer therapy. It can reliably provide one stage repair of sizable post-extirpation defects, with good functional outcome and acceptable esthetic result.