The palatal island flap on retrospection.

The place of the palatal island flap in present-day surgery is evaluated. Attention is drawn to the hitherto unrecognized fact that the first palatal island flap was executed decades before its general introduction in 1962. Its origins are discussed, and the subsequent process from its use as a panacea to the gradual evolution of its indications is described. Variations in anatomy, complications, success rates, and contraindications are reviewed. Attention is paid to the problems inherent in studies of palate surgery, both retrospective and prospective. A balance is made up of what has and has not been proven adequately. To date, no advantages over other palate-lengthening procedures have been established, while there is some evidence that it might in fact be deleterious to maxillary growth. As a result, at present, the palatal island flap is used mainly in closure techniques, as in fact was done by the first two surgeons using that it more than half a century ago.