The unique attributes of the radial forearm flap for head and neck reconstruction make it a primary choice from the reconstructive ladder. As more surgeons become familiar and comfortable with microvascular techniques and recognize the ease of its harvest, the popularity of this flap will increase. The radial forearm free flap should not be used for every head and neck defect. Flap choice should be dictated by the needs of the patient and those of the site to be reconstructed.