Background: Long-term tissue damage secondary to radiotherapy has been extensively studied, particularly radiation fibrosis, impaired wound healing and disturbances in microvasculature.[1] These effects pose challenges in reconstructive surgery regarding timing and outcome of tissue transfer and regeneration. Purpose: This review investigates the challenges radiation to grafts and flaps poses in plastic and reconstructive surgery that compromise surgical outcome and complicate further treatment. Methods: Academic databases PubMed, Google Scholar, NIH were used to conduct a comprehensive literature search with keywords radiation, radiotherapy, reconstructive surgery, graft, flap. Thirty of the most relevant studies were analysed regarding perioperative interventions of irradiated tissue and reconstructive techniques. Conclusion: Successful reconstruction of irradiated tissue is the result of careful surgical planning, timing and technique. Research shows free tissue transfer provides the most optimal outcome in irradiated tissue, followed by pedicled flaps, and lastly grafts.[1,2] Surgical timing in relation to radiation is specific to the area and if the patient has received perioperative optimisation management. Although the risk of osteoradionecrosis and flap failure exist, implementing strategies to mitigate radiation-related complications is shown to improve patient outcomes. References 1.Kaleem, O., et al. (2021). Free flap surgery in osteoradionecrosis of the head and neck. Frontiers of Oral and Maxillofacial Medicine, vol 3. 2.Deldar, R., et al. (2021). The "Double hit": Free tissue transfer is optimal in comorbid population with irradiated wounds for successful limb salvage. Journal of Plastic Reconstructive and Aesthetic Surgery, 74(6), p1246-1252.