Method of choice for reconstruction of large acquired scalp defects depends on numerous factors. The aim of our study was to analyze reconstructions of large acquired scalp defects performed on 135 patients in the period of 10 years. We have monitored factors having impact on reconstruction method, complications, and the content of achieved results. Skin grafts, local, regional and free flaps, have been applied for reconstruction of defects. We concluded that depth, size, defect localization, condition of surrounding tissue, comorbidities and causes of occurrence of defect have impact to a method of choice for defect reconstruction. Acquired scalp defects were the most frequent in the older population and, in the most cases, occurring upon the surgical removal of malignant tumors. Local fasciocutaneous flaps are a method of choice for small and acquired scalp defects of medium size while the free flaps are the best solution for reconstruction of the large full-thickness scalp defects. Frequency of severe complications was significantly higher in the patients with performed craniotomy, or the ones having liquorrhea.