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Middle Island Creek is a river, 77 miles (124 km) long, in northwestern West Virginia in the United States. It is a tributary of the Ohio River, draining an area of 565 square miles (1,463 km²) on the unglaciated Allegheny Plateau. It is the longest stream in West Virginia to be named a "creek."[5] The stream is named for Middle Island, which is located in the Ohio River at its mouth.[1]