INTRODUCTION Defects following head and neck surgery can often be closed using the technique of direct suture. This, of course, applies not only to the skin but also to the mucous membranes of the upper aerodigestive tract. This technique is used when the defect is small and where local conditions mean that enough tissue is available. However, for larger defects or in situations where direct suture is neither applicable nor available, surgical defects in the head and neck can be reconstructed with grafts, local flaps, regional flaps or free-tissue transfer. Occasionally, a combination of these different reconstructive techniques is required as ‘building blocks’ to reconstruct more complex defects. A graft is a piece of tissue that has no blood supply of its own and its survival depends on it gaining a blood supply from the recipient bed. A flap is a piece of tissue that has its own blood supply and does not rely on the recipient bed for its survival. This chapter focuses on the use of grafts and local flaps in head and neck reconstruction.