A new approach utilizing microsurgical composite tissue transplantation is advocated for the management of difficult reconstructive problems in the region of the head and neck. This method is especially useful when local flap coverage may be inadequate. Morbidity and hospitalization is reduced and reconstruction is complete upon discharge from the hospital. Extirpative surgery for a malignancy can now have the defect reconstructed immediately with less disfigurement and psychological insult to the patient and family.