Background The incidence of malignancies in the head and neck region is rising. Head and neck tumors are the eighth most frequent type of malignancy in German men, forming 3.3% of the total. As a result, the demand for functionally successful and esthetically pleasing reconstructions has increased. Methods Review based on a selective analysis of the pertinent literature and the guidelines of the German Association of Oral and Maxillofacial Surgery as well as the authors’ clinical and scientific experience. Results Microsurgical flap transfer has become the most important type of reconstruction, with a more than 90% rate of success, i.e., complete integration of the transplant in the recipient site. The most frequent complications are thromboses of the vein or artery of the pedicle. For each specific defect constellation, the most appropriate donor sites have been identified. Some donor sites are used for more than one defect. The principal risk factors for flap loss are prior operations on the neck, atherosclerosis, and previous radiation treatment. New developments include the use of perforator flaps, which can be anastomosed to very small vessels in the face, and wrist-carriers, which offer complete independence from head and neck vessels. Conclusion The treatment, rehabilitation, and follow-up care of patients with tumors of the head and neck must be carried out by an interdisciplinary team. Full awareness of the available options for reconstruction helps the radiation therapist, oncologist, psychooncologist, general practitioner, and dentist to coordinate their efforts and advise their often mutilated and sometimes suicidal patients effectively.