Extensive defects after ablative surgery of oral cancer, involving exterior skin of the cheek, demand for complex reconstruction. It often requires two free flaps, or double-skin paddle scapular-, radial forearm- or fibular-flap to reconstruct through-and-through cheek defects. The outcome is mostly described as successful and functional. Nevertheless donor site morbidity and functional impairment should not be neglected. This report describes the use of double-skin paddle perforator flaps from the lateral lower leg for combined intra and extraoral reconstruction after tumour resection. This kind of flap first avoids the need of an additional free flap, secondly it produces minimal donor site morbidity because of consequent preservation of the peroneal artery and primary wound closure. Thirdly it enables a good aesthetic outcome possible because of the primarily thin, pliable and variable skin paddles.