BACKGROUND. Head and neck cancers are related group of cancers that involve the oral cavity, pharynx (oropharynx, nasopharynx, hypopharynx), and larynx. Early-stage tumors of the upper aerodigestive tract can be cured; for late-stage disease, prognosis is poor. Nowadays microvascular free tissue transfer surgery performed at high level. Worldwide, this particular kind of operation in head and neck surgical field has become “golden standard” of treatment. Seemingly, plastic and reconstructive surgeons of developed countries widely perform forearm free flap, anteriolateral thigh free flap, fibula free flap, rectus abdominal free flap, latissimusdorsi free flap. We purpose to report our first 121 cases of Microvascular Free Tissue Transfer which had been performed at the head and neck surgical department, NCC of Mongolia. METHODS. The clinical records of first 121 cases patients who had microvascular reconstruction done between 2011 and 2017 were reviewed. The indications for surgery, choice of flap, duration of surgery and flap survival were noted. RESULTS. Our study were performed on 121 cases, among them 84.3% flaps were survived, most of defects occurred following cancer resection. Anterolateral thigh and radial forearm flaps were performed commonly for our reconstruction surgery. CONCLUSION. 84.3% free flap recorded success rate indicates our early experiences. Although the National Medical University do not have postgraduate reconstructive and plastic surgical training, we believe that meticulous planning, careful vessel selection, close flap monitoring as well as improved infrastructural support can lead us to much better success rates of microvascular reconstruction in our country.