AbstractForty‐three tissue transfers were performed in 41 patients for severe head and neck defects, no two of which were identical. Two thirds of the patients were in the pediatric age group (18 years or less), and 16 presented with severe radiation‐related defects. No bowel transfers are included in this group. The majority of the defects were complex, three‐dimensional defects in the cheek secondary to radiotherapy, surgery, or congenital defect. Free flaps were chosen to give the optimal aesthetic result and because they gave the best solution to the problem rather than the only solution. Total flap loss occurred in one patient, and partial loss occurred in two of the 43 flaps. No significant problems were encountered with either the radiotherapy or pediatric age group, although the complexity of the reconstruction was often greater. There were more flap‐related complications in the radiotherapy group, although these were al