The early experience of free flap reconstruction in a regional plastic surgery unit was reviewed. Forty-seven free flap surgical procedures were performed for 46 patients during a 2-year period from 1 January 1995 to 31 December 1996 in a regional plastic surgery centre that specialises in head and neck, and breast reconstruction. Twenty-six free transverse rectus abdominus myocutaneous flaps were performed for 25 breast cancer patients. Head and neck reconstructions were mostly performed after surgical ablation of oral and pharyngeal cancers. A variety of free flaps were used, including fibular osteocutaneous flaps, radial forearm fasciocutaneous flaps, jejunal grafts, and rectus abdominus musculocutaneous flaps. Lateral arm fasciocutaneous and scapular fasciocutaneous flaps were used for three patients who had foot ulceration. The success rate of free flap transfer was 94%. Flap loss was found in three patients who had pedicle complications that were due to traction, kinking, and thrombosis. There was no mortality in the series. The most common morbidity was wound infection. Two thirds of the free flap transfers were uneventful. Seven (15%) patients had major complications that required re-operation. Institutional support was essential for the development of microvascular surgery.