The island pedicle flap uses an island of skin that is detached from its epidermal and dermal attachments while retaining its vascular supply from an underlying pedicle to repair a cutaneous defect. Proper design of this flap requires familiarity with the anatomic and vascular basis of the flap and with technical aspects of flap mobility. Transposition, tunneling, interpolation, myocutaneous, and transcartilage variants of the island pedicle flap are discussed. This flap is most useful for defects on the upper cutaneous lip and eyebrow, but its use on the nose, ears, and periorbital area are indispensable for the repair of select defects.