The extensive blood supply to the scalp enables the use of local flaps based mainly on the superficial temporal artery: these include skin, temporoparietal fascia, subgaleal fascia, and temporal fascia. Also, the temporalis muscle provides flaps based upon the temporal branches of the internal maxillary artery. On top of the skull, scalp flaps, galeal flaps, and pericranial flaps can be used as random flaps or as axial flaps based on the problems or anatomic reasons that would preclude microvascular reconstruction. The pectoralis, latissimus, splenius capitis, and trapezius muscle flaps can dependably reach the base of the skull. The increasing reliability and versatility of microvascular reconstruction render their use standard for craniofacial reconstruction.