Summary: Free-tissue transfer has facilitated and refined the reconstructive surgeon’s ability to repair or reconstruct acquired or congenital defects in children. Although parallels exist between indications for free-tissue transfer in adults and children, the technical challenges and surgical skill required in pediatric patients are much greater and the level of complexity can escalate tremendously. Although this operation is difficult, the success rate is high and the results are often outstanding, with the benefit of growth and functional adaptation of the transferred tissue. Experience in this field is cumulative and creative thinking is often required. This article outlines the specific features unique to children, the most commonly used flaps, the expected results in specific regions, and the potential pitfalls to be avoided.