One-Stage Reconstruction of a Large Perioral-Cheek Defect Using a Modified Submandibular Angle Rotation Flap.

Reconstruction of large perioral defects is a major functional and aesthetic challenge, requiring stable closure while preserving lip mobility, facial symmetry, and a natural appearance. The Schrudde angle rotation flap is widely used but often requires distal extension for lower facial defects, leading to more dissection, tension, and risks of commissure distortion and scarring. We present a modified submandibular angle rotation flap that is horizontally mirrored and oppositely rotated, with the incision below the mandibular margin to reduce tension and conceal the scar. A 19-year-old male with a traumatic perioral-cheek scar underwent single-stage reconstruction after scar excision using this technique combined with postauricular cervical Z-plasty. Excellent 1-year outcomes were achieved following single-stage reconstruction of a 5.6×4.8 cm perioral-cheek defect, with ≥35 mm mouth opening, symmetric commissure, and intact oral competence. This modification provides a practical, aesthetically favorable alternative to the Schrudde flap and warrants further clinical study.