The fibula flap is an established ‘workhorse’ for mandibular and maxillary defects. We present results of an audit of 63 consecutive cases of the fibula free flap for reconstruction in head-neck surgery from one of the largest UK OMFS centres, performed over a 6-year period. The majority of cases (72%) were performed for SCC and the focus of the paper includes discussion of complications and success rate (94%), and explores the role of radiotherapy and co-morbidities in predicting failure for this flap. The importance of appropriate imaging modalities is highlighted, with emphasis on the role the MRA (magnetic resonance angiography) in flap selection over other possible modalities. Quality of Life implications of this flap are also raised, following a small survey of recent patients ( n = 19) using the Foot and Ankle Disability Index (FADI), which demonstrates that the impact of the fibula flap is generally minimal on day-to-day function, and is an acceptable and satisfactory donor site.