Successful head and neck reconstructive microsurgery requires a multidisciplinary approach involving specialists such as maxillofacial surgeons, plastic surgeons, otolaryngologists, anaesthesiologists, and nurses. It requires strict perioperative management of the patient, with special attention paid to parameters such as blood pressure, ventilation, and bleeding, which can all impact flap perfusion. In high-volume centers, specially-trained microsurgery units are available for optimal control of flap monitoring and management of all aspects of patient care. However, during the beginning of a microsurgery unit at a hospital unfamiliar with the demands of this field, easy-to-follow, but effective, measures must be in place to ensure adoption and adherence to post-operative care principles that confer higher success rates in head and neck cancer patients undergoing free flap reconstruction. While frequent observations can be labor-intensive, clinical monitoring remains the most suitable method during this early period and requires appropriate experience to be effective. Our aim is to emphasize the importance of clinical monitoring during the beginnings of a microsurgery unit by introducing an easy-to-follow clinical monitoring chart that covers both intraluminal and extraluminal causes of free flap compromise.