The objective of the study was to evaluate the safety and the efficacity of microsurgery in the elderly patient population. Between 2003 and 2005, 10 free-flaps were performed in 10 patients who were aged 70 years or older. One flap underwent reexploration, for an overall success rate of 100%. Medical complications in the postoperative period were further evaluated. Effects of American Society of Anesthesiologists (ASA) status, operation time, and age on complication rate were evaluated. Only ASA status was significant for the occurrence of postoperative medical complications; class 3 and 4 patients were at higher risk than class 1 and 2. Neither operation time nor age was predictive of postoperative complications. Microvascular free-tissue transfer is a safe and reliable option in the elderly population. The success rate of free-flaps is not different from that for other age groups. The rate of postoperative medical complications was 20%: most complications were in ASA class 3 and 4 patients.