This is a retrospective analysis from China of 881 free flaps over nearly four years, 49 of which were ‘taken back’, 26 of which were lost, giving a 97% success rate. The commonest cause of flap failure was venous thrombosis. The commonest cause of take-back that proved to be successful was haematoma. Free flaps with arterial concern tended to suffer worse outcomes than flaps with venous thrombosis. A history of irradiation was a statistically significant factor for free flap failure. Amongst others factors, age and previous neck surgery were not associated with adverse flat outcomes.