Background: Microsurgical reconstruction is providing new and dramatic treatment options for patients affected by cancer, trauma and paralysis. Free flap achieves repair effectively and faster. The present study was conducted for assessing microvascular anastomotic coupler devices (MACD) in head and neck reconstruction. Materials &Methods: A total of 100 patients scheduled to undergo head and neck reconstruction were enrolled. Complete demographic and clinical details of all the patients were obtained. Only those patients were enrolled which underwent microvascular free flap reconstruction using a MACD. The flap donor site, recipient vessels, and anastomotic technique were determined by surgeon preference. Microvascular complications were found to be due to either venous congestion or arterial insufficiency. Free flap complications were classified as either partial failure, late total failure (>5 days), or acute total failure (<5 days). All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Univariate analysis was done for evaluation of the level of significance. Results:A total of 100 patients were analyzed. The mean age of the patients was 51.8 years. Mean venous couple size was 2.5 mm and 3.5 mm in 33 percent and 56 percent of the patients. Most common recipient vein was external jugular and internal jugular vein found to be present in 33 percent and 55 percent of the patients respectively. Overall complications were seen in 8 percent of the patients. Venous congestion, vessel wall rupture, arterial insufficiency and total flap loss were the most common complications seen. Conclusion:There is a significant reliability of MACDs in head and neck reconstruction, even in small-diameter vessel reconstruction.