Microsurgical reconstruction is an integral part of the treatment following ablation for malignancy or trauma. Currently there are no clear treatment guidelines following tumour resection. This was recognised a few years ago and in 2008 various collaborative groups were founded as the German-Austrian-Swiss workgroup on tumours of the head and neck region – DOESAK. This group initially addressed questions on this topic in German speaking Europe in 2011 and later further refined and revalidated the questions in the rest of Europe in 2014. This is the third phase with the DOESAK questionnaire distributed worldwide. Thirty-eight units from Germany, Austria and Switzerland, 65 from remaining Europe OMFS departments and 226 units worldwide responded to the survey. There is wide agreement on the commonly used flaps and a trend towards primary bone reconstruction. However, that is where similarities end and as expected there is no uniform concept regarding osteosynthesis of bone transplants, microsurgical techniques, and supportive medication and postoperative monitoring protocols. In addition while microsurgical reconstruction is the gold standard in Europe, worldwide only every second unit has accesses to this technique. This is an interesting paper that proves different microsurgical protocols work in various situations.