INTRODUCTION Defects following head and neck surgery can often be closed by direct suture. This applies to both the skin and mucous membranes. This technique is used when the defect is small, and where local conditions allow adequate amounts of mobile tissue. However, for larger defects or in situations when direct suture is not applicable, surgical defects may be filled by free grafts, local skin flaps, with pedicled flaps that may be either axial cutaneous or musculocutaneous, or with free tissue transfer. This chapter outlines the use of pedicled flaps in head and neck surgery.