BACKGROUND: Soft-tissue and bony reconstruction with free-tissue transfer is one of the most versatile tools available to the reconstructive surgeon. Determination of flap perfusion and early detection of vascular compromise with prompt correction remain critical in free-tissue transfer success. The aim of this report is to describe the utility of laser-assisted indocyanine green fluorescent dye angiography in free-tissue transfer reconstruction. METHODS: From October of 2007 to March of 2008, 27 nonrandomized, nonconsecutive patients underwent surgical free flaps in conjunction with intraoperative Novadaq SPY fluorescent angiography. RESULTS: Twenty-seven patients underwent 29 free-tissue transfers. There was one partial flap loss in this group requiring operative revision. No complications attributable to indocyanine green fluorescent dye administration were noted. Imaging procedures (including dye administration) added minimal additional time to the operative time and anesthesia, and assisted in intraoperative decision-making. CONCLUSIONS: Novadaq's SPY fluorescent angiography system provides simple and efficient intraoperative real-time surface angiographic imaging. This technology places control of vascular anastomosis evaluation and flap perfusion in the hands of the surgeon intraoperatively in a visual manner that is easy to use and is helpful in surgical decision-making.