The aim of this study was to describe an innovation of the transposition pedicle island flap for reconstruction of the medium-sized skin defects in the face, neck and hand. Twenty-seven cases of skin tumours and scars were surgically excised and reconstructed with this island flap. ALL flap survived with primary healing postoperatively. With a follow-up from 1 to 22 months, functionally and cosmetically satisfactory outcomes were achieved. This modification of transposition island flap provides a competitive repair alternative for the treatment of medium-sized skin defects.