Reconstruction of head and neck defects after cancer extirpation is one of the most challenging surgeries for plastic surgeons. In addition to achieving reliable wound coverage to protect vital structures, restoring normal function and appearance is also the major tasks for head and neck reconstruction. Free flap surgery is the main treatment modality currently to achieve these aims through transferring suitable soft tissue and bone to the defects. Despite flap survival, the goals of head and neck reconstruction may still not be accomplished due to the complexity of head and neck structures. Here, we provide our experience in free flap surgeries for head and neck reconstruction to achieve a better outcome. Rapid prototyping 3-dimentional model fitted prebent plates and a fibular osteotomy device ameliorate contour deformity and reduce operation time in bone shaping. In considering through-and-through oromandibular defects, single flap reconstruction with fibular flap surgery is more suitable for combined mucosal and skin defect size less than 100cm2, or it might increase flap vascular events. Since most head and neck cancer patients in Taiwan are middle to old aged male and usually have habits of alcohol, betel nut, and cigarettes use, they are also high risk group for cardiovascular events. We found higher rate of perioperative acute myocardial infarction in these patients especially those with history of coronary artery disease or peripheral arterial disease. In conclusion, reconstruction results are usually suboptimal, and complications are not uncommon in head and neck cancer patients. Further refinements in surgery and care of these patients are important to reach a better reconstruction result.