Large defects in patients undergoing resections for malignant tumours and facial trauma represent significant challenges to the specialities of oncological, plastic reconstructive, maxillofacial and head and neck surgery since they require complex reconstructive surgical modalities. The range of operative plastic reconstructive surgical methods includes direct tension free closure of the wound, healing by secondary intention, mucosal or skin grafting, local flaps, distant pedicled flaps and the most complex distant free microvascular composite tissue transfer. Osseous reconstructions are possible with free osseous grafting of cancellous or cortical bone, alloplastic materials, metal plating and with free vascular composite bone transfer.