A one-stage nasolabial island flap isolated on the facial artery and vein is described for floor of mouth reconstruction. The donor site is closed primarily. The advantages of the procedure are that the one-stage procedure obviates the need for division and inset of a distant flap, the arterialized flap brings its own blood supply to the irradiated area; the donor site in elderly patients provides a large amount of redundant skin, which stretches easily across the midline or to the roof of the palate; and the donor defect is cosmetically acceptable. A disadvantage is that the procedure yields transient upper lip palsy and drooling that persists for several weeks.