This chapter discusses local flaps in facial, head and neck surgery, where some complex defects with massive tissue loss are more appropriately repaired with a regional flap or free tissue transfer. Local flaps may be of skin, muscle, fascia, and fat, and these flaps can be categorized based on vascular supply as random, axial, or free. The random flaps are typically supplied via perforator vessels through fascia or muscle to the overlying skin of which the most distal perforators to the skin flap require division during elevation. The blood supply to a random cutaneous flap is derived from musculocutaneous arteries near the base of the flap and the interconnecting subdermal plexus. Flap reconstruction may also create new planes of scar that may serve as channels for cancer recurrence and spread. Malignancies associated with rapid local and regional spread may require additional treatment. Classification of flaps may be based on location of donor site, blood supply, direction of transfer, or shape.