Surgical treatment of carcinomas and other malignancies in the head and neck region often require extensive surgery. These surgeries necessitate the development of various types of reconstructive flaps. Myocutaneous flaps are a relatively new reconstructive technique being used after radical head and neck surgery. These flaps utilize the axial blood supply that runs deep to the muscle masses as well as the cutaneous and subcutaneous tissue. By including the muscle when transferring the skin, the blood supply is transferred as well and allows a much greater range of rotation. Preoperative assessment and preparation of the patient directly impact the outcome of this surgery, especially in terms of nutritional management, oral hygiene, and assessment and correction of deficiencies in the pulmonary and hematopoietic systems. Also, many independent nursing implications and interventions are related to care of the myocutaneous flap. These include assessment, the promotion and maintenance of circulation, and prevention of complications such as infection and carotid artery rupture.