The purpose of our study was to investigate (by postal questionnaire) the long-term quality of life (QoL) in Chinese patients who have had resections of head and neck cancer and immediate reconstruction by radial forearm free flaps. We performed a retrospective questionnaire survey and case series in the Affiliated Tumor Hospital of Zhengzhou University. The subjects were consecutive patients treated for head and neck cancers during a 13-year period. The patients completed the University of Washington Quality of Life (version 4) questionnaires. Among the 178 patients treated during the course of 13 years, 87 were alive and disease free. Fifty-six (64.4%) of the 87 questionnaires were returned. The mean follow-up duration was 7.9 years (range, 3-13 y). Of the 12 disease-specific domains on the University of Washington Quality of Life, the best-scoring domain was pain, followed by mood, anxiety, and shoulder, whereas the lowest scores were for saliva, taste, and speech. The domains considered as the most important were saliva, speech, and taste. We conclude that the radial forearm free flap for the reconstruction of defects of the head and neck after resection for cancer significantly influenced the patients' long-term QoL.