The reconstruction of defects in the head and neck region has remained a challenging problem for head and neck surgeons. The amount of tissue loss may be extensive or the tissue destruction may involve composite elements. It is important to consider both the functional and aesthetic aspects while planning the reconstruction. The application of microvascular free tissue transfer allows the selection of the most appropriate tissue for reconstruction of the defect created following tumour extirpation. As these free tissues bring in new blood supply, wound healing is usually not a problem even if the region had received previous radiotherapy. Despite all the benefits associated with microvascular free tissue transfer these procedures remain associated with a small chance of failure. The application of pedicle tissue for reconstruction for certain defects still has a role in reconstruction of the head and neck region. The selection of the appropriate method and suitable tissue for reconstruction depends on the experience of the surgeon. Contemporary head and neck surgeons should consider all the reconstructive options before deciding on the optimal reconstruction method after adequate tumour resection.