Background: One of the most challenging methods is a free flap reconstruction in the third world: wanting in more endeavors. There is an intense requirement in the realm of training and experience in addressing head and neck defect issues. This study is aimed at expressing our experience with the free flap as a useful reconstruction method. Methods: Some patients were included as candidates in a retrospective study for free flap reconstruction, referring to diverse hospitals in different places in Tehran, Iran, from 2013 to 2020. Patients' demographic data, tumor profile, as well as flap results, were under assessment. Means (±Standard Deviation=SD), and median (with an interquartile range =IQR=Q1-Q3) for continuous variables; frequencies, as well as proportions for categorical variables, were reported. The variables' comparison among both groups – death or survival –was conducted employing either X2 tests or Fisher's accurate test for proportions; also, unpaired t-tests for means. Results: 330 individuals of patients undergoing 7 years of free-flap operation were under evaluation. The age ranged from 7 to 96 years, with an average of 51.91 ± 17.87 (Mean ± SD). The tongue (118, 37.6%) was the tumor's most typical origin; radial forearm flap (133, 40.3%), the most employed flap accompanied by anterolateral thigh flap (110, 33.3%). The success rate of free flaps surgery was 94 %, and merely 20 individuals of (6%) patients experienced flap necrosis; 21 individuals of patients (6.4%) died in the hospital after the surgical operation. Conclusion: In spite of the several limitations in our country as there are in other developing countries, the surgery of free flap reconstruction in head and neck defects has experienced an evolution in the last few years. In order to achieve better outcomes, we are supposed to mitigate the related issues to underlying diseases, patients suffering from, and the delay in the realm of detecting flap vascular complications in our setting.