Introduction: Reconstruction with a free flap is routinely done at site especially head and neck and oral because of better surgical and functional outcomes, improved esthetics results, and overall higher success rates.

Aim & Objective: To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions and  tudy various demographic and pre-operative factors associated with it.

Methods: This was a retrospective study of 45 patients undergoing reconstructions with free flaps from January 2020 to December 2022. Different types of free flap were performed like Anterolateral thigh, Free fibula osteocutaneous flap (FFOCF), free functioning muscle transfer  (FFMT), Free radial artery forearm flap (FRAF), The medial sural artery perforator (MSAP),
latissimus dorsi (LD), myocutaneous flap, superficial circumflex iliac artery perforator (SCIP).

Results: The patients included total 45 participants, with 35 men and 10 women, with a mean age of 45.56 years. Oral malignancy was the most common cause. Squamous cell carcinoma represented the majority of the diagnosed tumors (31.1%) followed by ameloblastoma. The most common recipient vessels were the internal jugular vein (91.4%), the facial artery (77.4%) followed by superior thyroid artery. The overall flap success rate was 93.33%. Venous thrombosis was the most common cause for re-exploration. The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site on 1 month follow up.

Conclusion: Microsurgical free flap seems to be a valuable and successful method in head and neck surgery. The reconstruction can be done by skilled surgeons with post-op monitoring.