This study was designed to compare the surgical outcomes and donorsite morbidities between the anterolateral thigh flap (ALTF) and the radial forearm flap(RFAF) for the reconstruction of head and neck defects, and to explore the advantages ofeach technique based on our single center experience. We undertook a retrospectivestudy of 86 patients with soft tissue defects of the head and neck region after cancerablation who were reconstructed using either an ALTF (n= 27) or a RFAF (n=59).Evaluation of the donor site morbidity was performed in 52 patients using a combinationof questionnaire and objective assessment. Surgical outcomes were recorded andcompared between the two groups. The ALTF required a longer harvest time than theRFAF but provided a wider skin area with larger bulk. Both flaps had long vascularpedicles and large caliber donor vessels for anastomosis. Flap survival rate and recipientsite-related complication rates were 95％ (56/59) and 9％ (5/59), respectively, for RFAF,and 96％ (26/27) and 4％ (1/27), respectively, for ALTF. Donor site morbidity in theRFAF group was slightly more severe than in the ALTF group. We concluded that bothALTF and RFF are reliable and versatile techniques to provide a reliable flap whenreconstructing head and neck defects. Selection of the proper donor site should be basedon individual patient factors and surgeon experience.