Background: There are no previous studies investigating the outcomes (medical complications, surgical complications, and overall survival) of patients undergoing free tissue transfers of the head and neck in three different hospital populations: private, public (county), and veterans administration (VA). Subjects: Consecutive patients who underwent free tissue transfers of the head and neck by a single surgeon between July 2000 and July 2008. Methods: Data were reviewed for pre-operative variables (prior irradiation and chemotherapy, American Society of Anesthesiologists (ASA) score); free tissue transfer characteristics (flap area, harvest and ischemia times); intra-operative variables (estimated blood loss, fluid administration); postoperative variables (medical/surgical complications, intensive care unit (ICU) and total hospital days); and posttreatment mortality. Results: There were 57, 47, and 61 patients comprising the study populations at the private hospital, public hospital, and VA hospital, respectively. Statistically significant factors were: age (mean years: 64.1, 51.9, and 62.6; P < 0.0001), intraoperative fluid administration (mean mL: 4,945, 6,273, 6,113; P = 0.008), ICU days (2.4, 2.0, 7.7; P < 0.0001), and total hospital days (9.5, 11.5, 17.0; P = 0.0002). Four (7%), five (11%), and four patients (7%), respectively, experienced total flap loss requiring an additional flap (P = ns). Prior irradiation and/or chemotherapy, ASA score, and free tissue transfer characteristics did not differ significantly among the hospital populations. There were no significant differences in posttreatment Kaplan–Meier survival curves (P = 0.299). Conclusion: Free tissue transfer can and should be performed in different hospital populations with comparably high rates of success. Theauthor maintained a high level of participation in the surgeries and postoperative care across the different hospital settings. © 2009 Wiley-Liss, Inc. Microsurgery, 2009.