Background: Microsurgical free flap transfer has been the most popular method for reconstructing head and neck abnormalities in the last two to three decades. Complex tissue transplants are among the many reconstruction alternatives offered by free FLAPs. This study's objective was to assess the clinical results of individuals undergoing various microvascular free flap reconstructions.

Materials and methods: This was a retrospective study of 133 patients undergoing reconstructions with free flaps from 2020 to 2023. Micro-vascular free flap reconstructions performed were: Anterolateral thigh flap (36.1%) and Radial forearm free flap (63.9%). Patients’ demographic data were collected, and the outcomes measured included flap survival complications and cosmetic outcomes.

Results: There were 85 radial forearm flaps (RFFF), and 48 anterior lateral thigh (ALT) flaps. The most common tumour location was buccal mucosa. The most common histology was squamous cell carcinoma (>90%). Venous thrombosis was the most common cause for re-exploration. Six patients underwent emergency surgical re-exploration. Fifteen patients had complications like Oro-cutaneous fistula (40%), surgical site infection (13.3%), recurrence (13.3%). The overall flap success rate was 92%.