The chapter provides a comprehensive overview of the principles, techniques, and considerations in the reconstruction of scalp injuries, ranging from minor defects to total avulsion. The scalp’s unique anatomical layers, rich vascular supply, and specific neurological innervation are crucial for understanding the complexities of scalp reconstruction. The authors describe various reconstructive options including primary and secondary closure, skin grafts, local and regional flaps, tissue expansion, and free flaps, each suited for different types and sizes of scalp defects. Special emphasis is given to the gold standard of replantation for avulsions, highlighting the importance of timely intervention and potential for singular vascular anastomosis due to the scalp’s extensive collateral flow. The chapter also discusses the challenges of ensuring aesthetic and functional outcomes, particularly in maintaining hairline integrity and managing large defects. The goal is to achieve optimal healing with minimal cosmetic and functional impairment, underscoring the necessity of a tailored approach based on the individual patient’s needs and the specific characteristics of the scalp injury.