Fifty-five double paddled flaps and five single paddled flaps were used to reconstruct large surgical defects in the oral cavity. There were no complications in 38 cases. Two patients died, one from diabetic ketoacidosis and the other after discharge with a possible pulmonary embolus. One flap necrosed completely due to technical error and required a latissimus dorsi flap. The most frequent complication was intra-oral dehiscence in 12 patients, six of whom developed oral fistula. Following debridement the wounds healed spontaneously without further reconstructive surgery. In the developing world the double paddled pectoralis major flap allows a one stage operation that provides bulk for large defects in the cheek with two epithelial surfaces and the donor site can be concealed by clothes. Oral feeds can normally be started from the third day and this is particularly important where sophisticated nutritional support is not available.