Objective: To analyze the feasibility of double free-flap transfers for reconstruction of extensive head and neck defects. Methods: Twenty-two consecutive cases of double free-flap transfers for extensive head and neck defects, performed from May 1999 to July 2001, were reviewed. Data concerning the operation included date of surgery, defect description and site, choice and combination of flap, recipient vessel and type of anastomosis used, and complications. Results: The fibula osteocutaneous-radial forearm fasciocutaneous flap combination was most commonly used (n = 14), followed by the fibula osteocutaneous-rectus abdominis myocutaneous flap (n = 5) and radial forearm-rectus abdominis myocutaneous flap (n = 3). The complete flap survival rate was 95% (42 of 44 flaps). Conclusion: In selected cases, the double free-flap procedure for reconstruction of extensive head and neck defects is justified and effective, and greatly improves the quality of life for these patients.