Pulp reconstructions use numerous techniques ranging from simple debridement to local and microsurgical flaps. The authors analyse the various treatments, in which directed healing still retains numerous indications. Local flaps have a definite place, but they are not devoid of risks (iatrogenic stiffness). The indications are presented schematically in table form together with several examples. A wide range of techniques is necessary in order to treat the various lesions appropriately. Large defects are best treated by microsurgical transfer of great toe pulp with satisfactory results, which justifies their management in specialised centers.