With the advent of microvascular surgery, application of free tissue transfers greatly facilitate the reconstrction of complex composite three-dimensional head and neck defects in one stage. The rectus abdminis flap is an excellent donor site in this regard. The flap is relatively easy to raise and has a vascular pedicle of large caliber with reliable versatile skin paddle. Also it is superior to other musculocutaneous flaps because the volume of the muscle and subcutaneous tissue can be easily adjusted to meet individual structural defect and has favorable positioning requirements during flap harvest. Seven rectus abdominis free tissue transfers were performed to reconstruct the head and neck defects. All flaps were based on the deep inferior epigastric vascular pedicle. The flap survival rate was 100% and reconstructive goals were achieved in all patients.