The reconstruction of the soft tissue defects after surgery of the head and neck cancer is a complex task.Optimal treatment requires the achievement of effective function and an acceptable cosmetic appearance by use of local and distal pedicled flaps, or microvascular free flaps.The choice of a flap depends on the site and size of the defect, on donor site availability, donor site morbidity, on the patients general healthy status, as well as on the surgeons experience.During the past 20 years, free-tissue transfers with microvascular anastomoses, such as the radial forearm flap and anterolateral thigh flap, provides pliable thin soft tissue to fill the large defects, though they lack colour match to the face and neck.In addition, these flaps need personnel trained in microsurgical techniques and special postoperative monitoring.High risk patients with advanced age or multiple medical issues are not good surgical candidates for microsurgery.Cervical pedicle flaps (platysma flap, submental island flap, stemocleidomastoid musculocutaneous,infrahyoid myocutaneous and supraclavicular island flaps) appears to be extremely suitable for medium-sized defects of oral cavity, pharynx and lower third of the face because of fast flap harvesting, proximity of the donor site to the original operating field, acceptable esthetic results at the donor site and minimal donor-site morbidity.Although various reports on the use of the cervical pedicle flaps have been published, there is still some controversy over their advantages and disadvantages, as well as the specific indications for them.Modifications (improvements) of the surgical techniques of flap harvesting, its influence on flap survival, indications and limitations for reconstruction of orofacial defects,especially defects after excision of oral cancer, are discussed based on authors experience and literature reports.