The surgical defect after radical resection in the head and neck region is extensive and often involves skin, oral mucosa and bone. Primary reconstruction allows for rapid restoration of function and rehabilitation of the patient. We report a series of 93 patients with oropharyngeal reconstruction after ablative surgery in the head and neck. For reconstruction, there were 41 pedicled myocutaneous flaps, 18 random flaps and 7 vascularised free flaps. There were 3 partial and 1 complete flap failures together with 5 persistent fistulas. The factors considered in the choice of reconstruction and our philosophy in this regard are discussed.