Objective: To review the reconstruction of large scalp defects after skin cancer of the midfrontoparietal region with an O-Z flap associated with a total skin graft. Method: information was obtained through photographic records and medical records of patients operated on at the Plastic Surgery Service of PUC-RS and literature review. Conclusion: It is very important to be familiar with the superficial vascularization of the skull to increase the success rates of the OZ flap, and also to be prepared to use a skin graft if the flap closure presents excessive tension or is not able to provide full coverage of the defect.