Microvascular free flap reconstruction has become standard of care in management of head and neck cancer. It requires surgical skills and team work to perform this type of complex surgery. For successful outcome in microvascular surgery, several factors need to be considered. These are careful assessment of the patient before operation, surgical technique in harvesting flap tissue and preparing the recipient vessel for revascularization, perfect microvascular anastomosis and positioning of pedicle to avoid tautness or kink in the vascular pedicle. Tissue defect around the head and neck region is a challenge for reconstructive surgeons. Adequate resection would result in large complex defects that are difficult to reconstruct with conventional flaps. Inability to reconstruct such large defect is a limiting factor in offering these patients curative treatment. Reconstruction with free flap provides an opportunity to treat these patients and improve their functional and cosmetic outcome. Microvascular reconstruction is still considered a specialised procedure that needs infrastructure, support services and a team approach in addition to surgical skills.