Aims: Microsurgical free tissue transfer is the standard for complex head and neck reconstruction, but large longitudinal data from Southeast Asia are scarce. We describe the demographic profile, referring specialty distribution, flap utilisation, and post-operative flap survival of head and neck free flap reconstructions at an Indonesian national referral hospital. Methodology: We retrospectively reviewed a prospectively maintained institutional microsurgery database of all free flaps performed from 2014 to 2026. Of 1,200 free flaps, 869 (72.4%) were head and neck reconstructions and formed the study cohort. Demographics, referring specialty, defect site, flap type, and flap vitality were analysed descriptively; survival was calculated for evaluable cases. Results: The cohort comprised 451 males (51.9%) and 418 females (48.1%); mean age 40.2 ± 18.3 years (range 2–98). Operation was performed jointly with several specialties; among documented referrals, the most common were surgical oncology (40.4%), oral and maxillofacial surgery (27.8%) and otorhinolaryngology (21.5%), with ophthalmology, neurosurgery and cardiothoracic surgery also represented. The mandible was the common defect site (47.7%), followed by maxilla (16.2%) and tongue (4.9%), with tumour pathology predominating. The fibula free flap was most frequent (51.0%), followed by the anterolateral thigh (ALT) flap (29.3%) and radial forearm free flap (RFFF, 16.2%). Overall flap survival among evaluable cases was 91.5%, with an 8.5% failure rate. Survival was highest for fibula (94.3%) and RFFF (94.2%) flaps, and 86.9% for ALT flaps. Conclusion: This 12-year series shows that head and neck free flap reconstruction can achieve internationally comparable survival (>90%). The predominance of mandibular defects and fibula flaps reflects the regional burden of jaw pathology and supports continued multidisciplinary microsurgical capacity-building. Keywords: free flap; head and neck reconstruction; microsurgery; flap survival; Indonesia