Purpose Local flaps remain an important tool in the plastic surgeon’s armamentarium in optimising a patient’s aesthetic and functional outcome. Based on an axial pattern blood supply, the superficial temporal island flap encompasses the advantages of versatility, pliability, and potential for composite tissue reconstruction. It is protean flap in scalp, forehead, temporal and pre-auricular region recon. This retrospective review outlines the anatomy, operative technique and clinical applications of the superficial temporal island flap. Methodology We present the surgical technique and twenty-two cases over a five-year period of single stage reconstruction of facial defects with the superficial temporal island flap in the setting of oncological resection. Results All flaps survived. One flap experienced delayed wound healing at its inset and one flap disrupted the frontal hairline. Average defect size was 3.5 cm x 2.7 cm on histological review. Cases included scalp, forehead, temple and pre-auricular region defects. Mean follow up was 195 days. Conclusions The flap provides hair bearing resurfacing, avoids discarding healthy tissue, and does not introduce an upward distorting vector to the face when utilised. The superficial temporal island flap is a versatile and reliable flap for reconstructing facial defects.