With an aging population, free flap reconstruction for head and neck cancer ablation in the elderly is becoming more commonplace. In nonagenarians, however, such major operations are still rarely offered due to its physiological demands. We report the first case of successful resection and reconstruction of head and neck cancer with a free perforator flap in a 96 year old patient. We feel that with careful patient and flap selection, careful preoperative workup and close collaboration between treating teams, age alone should not preclude patients from receiving the best possible curative treatment and reconstruction in head and neck cancers. Even in nonagenarians, perforator free flaps, such as the anterolateral thigh flap, can be used safely to achieve good functional and aesthetic outcomes.
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