Background Reconstruction of recurrent head and neck malignancy especially in the presence of a frozen neck is challenging. The superficial temporal vessels would be ideal as recipient vessels because they lie out of the previous surgical and radiation field. Methods We conducted a retrospective case‐control study based on our database between January 2013 and June 2016. A total of 581 primary cases were selected as controls. The 60 test group patients had (a) recurrent head and neck reconstruction, (b) previous surgery and irradiation, (c) frozen neck, and (d) superficial temporal vessels as recipients. Results There was no significant difference between vascular compromise rates of superficial temporal vessels (anterograde and retrograde limbs) and controls (P > .05). Flap success rate of the test and control group is comparable, 95% vs 98% respectively. Conclusion Superficial temporal vessels, both anterograde and retrograde, should be the first consideration for recurrent intraoral, facial, and scalp reconstruction with frozen necks.

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Background: Most skin paddles of the fibula flap are harvested from the distal third of the lower leg, skin grafting for the donor-site is necessary. Methods: A retrospective review was done on patients with large bony defects using free fibula osteocutaneous flaps (FOSCFF) for head and neck reconstruction. We focus on the techniques for closure of donor sites were skin grafting, primary closure with tear drop design and propeller flap technique on the donor site closure using skin graft, primary closure and local propeller flap based on the different location of perforators of FOSCFF. Postoperative follow up include incidence of wound complications, postoperative days to ambulation and cosmetic outcome. Results: A total of 48 patients were included. Twenty five patients had skin graft (Group A), and 23 patients had primary closure (Group B); in 16 patients tear-drop design was used, 6 had propeller flap, and the remaining 1 patient received a chimeric flap. Group A had more wound complication rates compared to Group B; 20% versus 4.3%, respectively (p = .19). The average postoperative days to ambulation for Group A were 15.1 days versus 7.3 days for Group B (p < .001). The cosmetic score in the B group (2.71) versus A group (4.89) was also statistically significant (p = .007). All the patients ambulated well at follow up. Conclusion: Primary closure using the tear drop technique and propeller flap is superior to skin grafting in terms of better cosmetic appearance, earlier postoperative ambulation, and no need for another donor site for skin graft.

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Otolaryngologists' awareness of underlying haematological pathologies and their natural course of disease in cases of severe airway haemorrhage is of paramount importance in anticipating evolving issues in management of these patients.