The reconstruction of full-thickness scalp defects remains a surgical challenge. Different types of reconstruction had varying success including the use of dermal regeneration template (DRT). We reviewed the surgical outcome of 30 patients who underwent application of DRT for resurfacing of full-thickness scalp defects when the pericranium was excised and the outer cortex of the calvarial bone was burred after the excision of scalp neoplasm. This was a retrospective review of 30 patients who had scalp reconstruction with DRT undertaken by the senior author between October 2004 and June 2007. The mean age of patients in our series was 63 years (37-91 years). There were 14 men and 16 women. The indications for re-excision and DRT reconstruction in 28 patients were close margins and aggressive tumor type, whereas 2 patients had a recurrence. The mean defect size was 95 cm2 (16-275 cm2). The second stage of the reconstruction occurred on postoperative day 42 (postoperative days 27-62). The mean follow-up period was 14 months. Two patients had minor complications. For both stages, the combined average operative time was 128 minutes. The use of DRT is a rung of the reconstructive ladder that deserves consideration. In our series of 30 patients who required secondary reconstruction of complex scalp defects, the use of DRT has been seen to provide safe and durable soft-tissue cover for full-thickness scalp defects. The reduced operative time and inpatient stay are desirable characteristics particularly in elderly patients with multiple comorbidities.