The use of saphenous vein as an interpositional vein graft is indicated in free flap reconstruction when the flap pedicle length is inadequate to reach the suitable recipient vessels. It provides a valuable option in complex reconstruction of large wound that requires free tissue transfer but with inadequate recipient vessels, especially in the use of small flaps in head and neck area where there is a need for a large venous outflow to accommodate the robust arterial inflow. We report the retrospective review of 14 patients who has undergone the free flap reconstructions with the saphenous vein interpositional graft to lengthen the pedicle. From August 1997 until November 2002, 14 patients underwent free flap reconstruction with interposition vein graft. There were 10 males and 4 females. The patients’ ages ranged from 12 to 79 years old. The defects ranged in size from a small bony defect to 30 x 12 cm. Eight of the flaps used were latissimus dorsi, 4 were vascularized fibulas and 2 were rectus abdominus flaps. All the vein grafts used were saphenous vein, and all measured greater than 20 cm. All 14 cases used the loop graft method. Operative time ranged from 5.25 to 12.5 hours (mean of 6.5 hours). The estimated blood loss ranged from 250 cc to 1000 cc (mean of 400 cc). There were no intraoperative complications. Hospitalization length ranged from 6 to 32 days (mean of 12 days). There were two major complications: early arterial thrombosis and venous thrombosis. Both flaps were salvaged. In our review, the use of saphenous vein grafts in free flap reconstructions is a good, viable option when adequately-sized donor vessels are not available, and its use is not associated with higher flap failure rate compared to the non-vein graft free flaps.