This chapter outlines the essential reconstructive concepts regarding anatomy of the scalp and surgical planning, highlighting potential areas for complications, as well as provide the author’s suggestions based on the location and size of the defect. Surgical reconstruction of the scalp is a highly individualized procedure where a thorough understanding of the anatomy and meticulous presurgical planning is of utmost importance. Surgery on the scalp is performed for a variety of reasons including incisional or excisional biopsy, removal of benign or malignant lesions, cosmetic purposes, or reconstruction after traumatic injury among many others. A variety of techniques for reconstruction and wound closure can be utilized depending upon the aforementioned factors. Depending on the surgical defect, the reconstructive treatment ladder includes healing by granulation, and secondary intention, primary closure, local skin flaps, full-thickness or split-thickness skin grafts (FTSG/STSG), as well as tissue expansion. The physician must assess the depth of injury or excision needed, as well as the quality of the tissue at the surgical site. The patient’s comorbidities and personal preferences must also be considered.