The palatal island flap was first described in post-ablative head and neck reconstruction by Gullane and Arena in 1977. It is a well-vascularized mucoperiosteal regional flap pedicled on the greater palatine neurovascular bundle. The flap is reliable, sensate, and has little donor site morbidity. The palatal island flap can be utilized in select intraoral or oropharyngeal defects.