A total of 75 cases of microsurgical composite tissue transfer to reconstruct defects of the head and neck, trunk, upper and lower extremities performed at the American University of Beirut Medical Center between January 1992 and December 1997 were evaluated in a retrospective study. There was a failure rate of 6.6% and a complication rate of 13.3%. Our results show that free tissue transfer can be considered as a safe and viable treatment option in a wide variety of clinical situations including early soft tissue coverage of complex extremity wounds, limb sparing procedures for malignant neoplasms, reconstruction of the head and neck area, treatment of chronic osteomyelitis, and finally reconstruction of the foot in patients with severe diabetic neuropathy and peripheral vascular disease. A brief discussion of the history of microvascular free tissue transfers as well as their value in modern reconstructive surgery is also presented.