Purpose: To assess the results of different soft free flaps in reconstruction of oral and maxillofacial defects.

Methods: 2787 patients with 2922 soft free flaps from 1979 to 2010 were involved in this retrospective study. Soft free flaps included forearm flap, latissimus dorsi myocutaneous flap, pectoralis major myocutaneous flap (PMMF), anterial lateral thigh flap and lateral arm flap, etc. These flaps were used to reconstruct the defects of the tongue, palate, cheek, floor of mouth, etc. The successful rate was assessed during different periods.

Results: The successful rate increased from 92% in 1980s to 98.5% nowadays, 96.8% in average. The forearm flap was the most common flap in reconstruction of the defects (accounted for 80.5%), latissimus dorsi myocutaneous flap and free PMMF were always used in reconstruction of combined defects. The anterial lateral thigh flap had been paid much more attention in recent years due to its advantages.

Conclusion: Reconstruction with free flap afforded the great possibility for tumour resection. Forearm flap was the best for tongue, cheek, floor of mouth reconstruction. Latissimus dorsi myocutaneous flap and PMMF were the favourite for huge bulk defects. Whereas the anterial lateral thigh flap provided us much more flexible choice for reconstruction of the different defects. So the free flap transplantation was the mainstay of oral and maxillofacial reconstruction. Selection and application of proper flap was important to aesthetic and functional rehabilitation.