Large periauricular and temporal bone defects most commonly follow resection of advanced nonmelanoma skin cancers. Reconstruction aims to cover the cutaneous defect and adjacent vital structures with the ability to heal in an irradiated field and withstand further treatment. Preferred reconstructions are class I, cervicofacial rotation or radial forearm free flap; class II, anterolateral thigh; and class II, rectus abominis free flap. Ancillary procedures, especially for associated facial paralysis, often are required. Although free flap reconstruction provides rapid wound healing, local and regional flaps are alternatives for patients unable to tolerate prolonged anesthesia and for use after recurrence or complications.