For patients with advanced stages of malignancy, local treatment will improve the quality of life by relieving pain, simplifying daily treatments, controlling hemorrhage and reducing the mental burden. Therefore, palliative surgery as a modality of local treatment aimed to maintain activities of daily living should be performed accurately. When planning palliative reconstructive surgery, several factors must be taken into account such as the patient's performance status, the surgical site condition, treatment history, and surgeon's skill. Here, we present three cases of palliative reconstructive surgery with free flaps, all of which were successful without any complications. Regarding palliative reconstructive surgery, free flaps may be a useful choice. In certain cases, aggressive use of free flaps beyond the reconstruction ladder is more effective than other methods such as skin grafts, local flaps and pedicled flaps. To achieve the best outcome, consideration for individual patients and solid surgical skills are warranted.
