Objective: To investigate the results and complications of pectoralis major myocutaneous flap (PMMF) reconstruction in our department. Methods: Twenty-three patients who underwent head and neck cancer resection and reconstruction with PMMF in our department between 1988 and February 1998 were reviewed retrospectively. Results were assessed according to complications and risk factors. Results: Flap-related complications developed in 9 patients (39%); these were intraoperative vascular injury, total/partial flap necrosis, fistula formation and flap/suture line dehiscence. Blood albumin level was the most important risk factor for the development of complications. The median length of hospitalization for patients developing complications was 59 days compared with 18 days for those who did not develop complications. Conclusion: Although variable new techniques for head and neck reconstruction are described, the PMMF still remains an excellent tool for single-stage reconstruction in the head and neck region. Unfortunately, the true complication rate after reconstruction with PMMF is not low. Many complications are undoubtedly related to risk factors and prolong hospitalization. These risk factors should be carefully considered and, if possible, treated preoperatively. Alternative reconstruction techniques should also be considered, and following general guidelines the best technique should be selected for each individual case.