Pediatric burn reconstruction has made significant progress in the past 75 years. Advances in acute burn care have greatly improved patient survival, particularly in children, resulting in a large number of pediatric burn survivors who require reconstructive surgery for a wide range of deformities. These deformities can range from small areas of superficial scarring with no associated contractures to the most extensive and complicated deformities imaginable following massive burns. The goal for all these patients should be to restore them as closely as possible to their pre-injury state. Keeping this goal in mind from the first presentation of a burned child is essential to achieving the best possible outcome. The best outcomes require choosing the best reconstructive options while minimizing iatrogenic deformities. The goal of this chapter is to describe an overall reconstructive strategy and present selected examples that will emphasize what is possible today.