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Full thickness total scalp avulsion injuries present a complex reconstructive challenge. Here we present a case of a 32-year-old female with an extensive full thickness scalp avulsion injury from a fishing boat engine accident that led to a unique injury pattern and loss of pericranium. This case report demonstrates the effectiveness of acellular dermal matrix and split thickness skin grafting in reconstruction of full thickness scalp avulsion injuries where there is significant loss of pericranium. After this patient's reconstruction, six-month postoperative follow up demonstrated an acceptable functional and esthetic outcome.