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To review the recent literature on the expanding use of the anterolateral thigh free flap for head and neck reconstruction.The versatility of the anterolateral thigh free flap allows it to be raised as a subcutaneous, musculocutaneous, fasciocutaneous, or adipofascial flap. In recent years, it has been reported to reconstruct defects involving the scalp, skull base, pharynx, tracheal stoma, oral cavity, and oropharynx. Various techniques have also been described in its harvest and inset, including combination flaps in conjunction with other free flaps or bone grafts, chimeric flaps, double-paddled skin flaps, and sensate flaps. These reports confer good functional and aesthetic outcomes equal to or better than other fasciocutaneous free flaps.The role of the anterolateral thigh free flap in reconstructing head and neck defects is ever expanding, with many novel harvesting and reconstructive techniques described in recent years. Because of the large surface area of the anterolateral thigh, as well as the ability to tailor variable amounts of skin, muscle, fat, or fascia associated with this flap, the reconstruction options are numerous. More importantly, good functional and aesthetic outcomes are achievable with an associated low morbidity of the donor site.