Resecting head and neck cancers, benign tumours and major trauma to the face and neck can create large defects that have a profound effect on cosmesis and function. Over the past 25 - 30 years significant advances have been made in improving patient's functional and aesthetic outcomes following creation of these defects. Most of the advances have been in reconstruction of the defects with autologous (the patients own) tissue. A number of important anatomical donor sites have been identified from where complex tissue can be removed with its own blood supply with minimal donor site problems. Some of these sites are near the head and neck so the tissue can be moved but is anchored by a pedicle (pedicled or regional flaps) and some are from distant sites. The tissue from these distant sites is brought up with an artery and vein that are then anastomosed (joined) to blood vessels in the neck to ensure a robust blood supply. This technology is called Free Tissue Transfer and the components are referred to as Free Flaps. For more information on head and neck reconstruction see www.thyroid.co.nz