AIM: Scalp reconstruction has always been a challenging task, in particular after oncological demolition and this article gives an overview on the state of the art in scalp reconstruction strategies. MATERIAL OF STUDY: We elaborated a systematic algorithm for scalp reconstruction based on location and size defects, presence or absence of periosteum, bone involvement, the quality of surrounding scalp tissue, the presence or absence of hair, location of the hairline, patient comorbidities and different procedures commonly used in plastic surgery. RESULTS: Our algorithm allows plastic surgeons to perform scalp reconstruction after the most devastating of defects. DISCUSSION: Successful reconstruction of the scalp requires careful preoperative planning and detailed knowledge of scalp anatomy, hair physiology, variety of available local tissue and plastic surgery procedures as well as synthetic substitutes or products provided by tissue engineering. CONCLUSION: However, the challenge today is to do so with excellent cosmetic results.