For the reconstruction of large scalp and middle facial defects using free flaps, there are several options for the recipient vessels. Among them, the superficial temporal vessels are proximate to the defect. However, the reliability of these vessels remains controversial. In this report, we retrospectively investigated the recipient vessels and postoperative outcomes of 25 patients who underwent microsurgical scalp or middle facial reconstruction. Among these 25 patients, the reconstructed sites were: the scalp in 12, eyelid in 4, orbit in 3, and upper jaw and cheek in 6. Superficial temporal vessels were selected in 17, facial vessels in 2, occipital vessels in 2, and cervical vessels in 4 patients. In 17 patients in whom superficial temporal vessels were used as the recipient vessels, there were 1 cases of vein thrombosis, 2 case of insufficient caliber of the vein, and 1 case of arterial thrombosis. All of these patients required re-anastomosis to cervical vessels. On the other hand, there were no complications among the recipient vessels for which cervical vessels were used. Our study suggests that it is necessary to plan preoperatively for the option of anastomosing to cervical vessels.