KQ 17.1. The success of a free flap diminishes if it fails to secure an artery or vein for anastomosis. Therefore, in cases where the pedicle cannot reach the recipient vessel, a vein graft may be necessary. If securing the usual arteries proves challenging, alternative options may be considered. KQ 17.2. The donor artery of the free flap generally exhibits comparable sizes, facilitating surgery without major complications. However, limitations may arise in salvage cases. To address discrepancies in vessel diameter, various techniques are employed, such as using a dilator or an end-to-side anastomosis approach. KQ 17.3. Recipient artery selection significantly impacts free flap reconstructive success. The features of an ideal recipient include minimal donor-recipient size mismatch, tension-free anastomosis, expansile pulsation, and robust arterial flow. Alternatives, such as the transverse cervical or superficial temporal arteries, must be considered when plaque limits the usage of commonly used arteries. KQ 17.4. The success of anterolateral thigh (ALT)-free flap procedures relies on the careful identification and meticulous dissection of perforator arteries. Preoperative assessment is critical. In challenging cases, a myocutaneous type (if skin blood supply is intact) or a muscle-only type of ALT-free flap can be employed. Contralateral thigh exploration can be considered.