Learning Objectives: When reconstructing large mastoid cavities, the surgeon's repertoire should include a technique that uses a vascularized lining to optimize patient outcomes.

Introduction: Complications following open cholesteatoma surgery arise when mastoid cavities fail to epithelialize. The Hong Kong flap is a fertile substrate of vascularized temporalis fascia lining that facilitates rapid epithelial lining. We have studied the long term outcome of this technique and reviewed its role in cholesteatoma surgery.

Methods: We analyzed data obtained from records of patients who have had cholesteatoma surgery in the Prince of Wales group of hospitals through the period from 1987 to 2015. The outcome measures included relevant clinical parameters such as time to achieve a dry ear, requirement for a second look procedure and the primary surgeon's level of experience.

Results: The Hong Kong flap reconstruction was not utilized in all of cholesteatoma operations over this period. In patients reconstructed with the Hong Kong flap, the median time to dry ear was 2 months. 20% needed a second look or more and 8% were found to have recurrent or residual cholesteatoma. Surgeons with varying levels of surgical experience successfully performed the procedure.

Conclusions: The Hong Kong vascularized temporalis fascia flap is a technique within the capability of average otologists. The post-operative course is categorized by rapid healing and long term healthy, trouble free cavities. The requirement for second look procedures is significantly reduced.