Although many large series of free tissue transfers for head and neck reconstruction have been reported in adult, there are few studies in pediatric patients. Seventy-three free tissue transfers for reconstruction of various defects of head and neck were performed in 72 pediatric patients between January 1990 to September 2002, over a 12 years period at our center. The average age at the time of reconstruction was 11.8 years (range; 2 to 17 years). 38 patients were female and 34 were male. There were nineteen tumor resection defects, eighteen congenital oro-nasal fistula defects (cleft palate), eleven posttraumatic defects, nine corrosive pharyngeo-esophageal injury, eight burn contracture, six hemifacial atrophy and microsomia, and one fascial paralysis. Thirty-nine fasciocutaneous flaps, sixteen osteoseptocutaneous flaps, ten muscle or myocutaneous flaps, and eight jejunal flaps were transferred. All flaps survived, except one had partial necrosis. The success rate was 98.6 percent. Five patients (6.76%) required re-expolaration. There were two venous thrombosis, and three arterial thrombosis. All five flaps were successfully salvaged. This study confirmed free tissue transfer as a safe, reliable and time effective method for the reconstruction of various head and neck defects in children.