www.PRSJournal.com 584e L ingual flaps are an outdated but effective solution for intraoral reconstruction with local mucosal tissue. 1 However, the need for two surgical stages and the patient discomfort dur- ing flap delay have limited their popularity. Other local mucosal tissues are often inad- equate for repair of moderate to large oral defects in one stage, and cutaneous free flaps are often the first option for reconstruction of such defects but add complexity to the operation and bring skin into the oral cavity. The introduction of per- forator and propeller flaps has expanded the pos- sibilities of reconstructing complex defects in a single stage with local tissue. 2–9 Disclosure: The authors have no financial interest to declare in relation to the content of this article. Copyright © 2015 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000000956 Adriana Cordova, M.D. Francesca Toia, M.D. Salvatore D’Arpa, M.D., Ph.D. Gabriele Giunta, M.D. Francesco Moschella, M.D. Palermo, Italy Background: Lingual flaps provide ideal mucosal coverage for intraoral defects but traditionally require two surgical stages. The authors present an axial mucosal propeller flap for single-stage intraoral reconstruction. The flap includes the mucosa of the lateral side of the tongue, islanded on the deep lingual vessels. Methods: Between 2011 and 2013, 23 patients underwent intraoral mucosal reconstruction with a deep lingual artery axial propeller flap after cancer resec- tion in the cheek (n = 16), floor of the mouth (n = 2), retromolar trigone (n = 2), hard palate (n = 2), and soft palate (n = 1). Mean defect size was 19.5 cm 2 . Preoperative and postoperative intraoral function was evaluated with the Functional Intraoral Glasgow Scale. Results: The authors always achieved one-stage reconstruction with primary donor-site closure. The only complications were an infection treated conserva- tively and a late oronasal fistula caused by radiotherapy. All patients resumed an oral diet after 1 week and none required surgical revision. Mean 12-month postoperative Functional Intraoral Glasgow Scale score was better than the preoperative score (13.5 versus 12.8). Conclusions: The deep lingual artery axial propeller flap combines the advan- tages of the traditional lingual flap (i.e., reliable axial vascularization and like- with-like reconstruction) with those of a propeller flap (i.e., one-stage transfer of like tissue and extreme mobility) and has wider indications than a conventional lingual flap. The technique is fast and has low morbidity and good functional results, and the authors recommend it as a first-choice technique to reconstruct moderate to large intraoral defects. (Plast. Reconstr. Surg. 135: 584e, 2015.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. From Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo. Received for publication July 4, 2014; accepted September 2, 2014. Presented at the 25th Annual Meeting of the European Asso- ciation of Plastic Surgeons, in Ischia, Italy, May 29 through 31, 2014. A New Mucosal Propeller Flap (Deep Lingual Artery Axial Propeller): The Renaissance of Lingual Flaps Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www. PRSJournal.com). RECONSTRUCTIVE