This article provides a thorough summary of the current techniques available in head and neck reconstruction. It details the challenge of restoration of form and function posed by the shape of the craniofacial skeleton and soft tissue. The introduction on current techniques is useful and is built on by describing how scaffolds, bioreactors and in vivo bioreactors may overcome current shortcomings in regeneration. Perhaps most interesting are the case reports of prevascularised flaps. They explain well the principles of defect characterisation, bioreactor design, prefabrication and finally repair. Although currently high throughput use of such technology is not possible, readers will develop a sound understanding of the impending developments in the field from this article.