The island pedicle flap has in comparison with other skin flaps a number of important advantages which include elasticity, minimal shrinkage, absence of dog ears, success in irradiated areas and innecessity of a second stage procedure. On the head the most common donor areas for an island flap are postauricular, nasolabial, submental, and less cosmetically satisfying frontal and temporal regions. For large reconstrictions, however, only those pedicles which contain a branch of the superficial temporal or frontal arteries suffice. The major indications for an island pedicle flap include defects of the auricle, stenosis of the external auditory canal, through and through defects of the nose and paranasal region, in combination with other methods of skin grafting, and soft tissue loss and ectropion of the lower lid.