The objective of this study was to evaluate the safety and thus the efficacy of microvascular free tissue transfer in the elderly patient population. Free flaps for different types of reconstructions were analyzed to verify whether free tissue transfer is feasible in the elderly. Between 1993 and 2003, 102 free flaps were performed in 94 patients who were aged 70 years or older. There were 75 male and 19 female patients, with a mean age of 73.8 years (range, 70 to 87 years). Different types of free flaps were performed for head and neck (n = 78), lower extremity (n = 12), and trunk and upper extremity (n = 4) reconstruction. Nine flaps underwent reexploration and four of them were lost, for an overall success rate of 96 percent. Medical complications in the postoperative period were further evaluated. A total of 32 medical complications were seen in 29 patients. Only one patient died because of postoperative complications. The frequency of medical complications was further analyzed in detail. Effects of American Society of Anesthesiologists status, operation time, and age on complication rate were evaluated statistically. Only American Society of Anesthesiologists status was statistically significant for the occurrence of postoperative medical complications; class III and IV patients were at higher risk than class I and II. Neither operation time nor age was predictive of postoperative complications. Microvascular free tissue transfer is a safe and reliable option in the elderly population. The success rate of free flaps is not different from that for other age groups. The rate of postoperative medical complications was 31 percent (29 of 94 patients); most complications were in American Society of Anesthesiologists class III and IV patients.