Whale-tail-shaped mucocutaneous flap for the reconstruction of electrical burn at the labial commissure: a case report.

Introduction and importance: Electrical injuries in children are uncommon but may cause disproportionate functional and esthetic sequelae, particularly in the perioral region. Even small oral commissure defects can disrupt oral competence, symmetry, and vermilion continuity. We present a pediatric case of a full-thickness labial commissure defect following a low-voltage electrical burn, reconstructed with a local whale-tail-shaped mucocutaneous flap. Case presentation: A 6-year-old boy sustained a low-voltage electrical burn to the left labial commissure after biting a charger cable. Examination showed a full-thickness commissural defect with incomplete oral closure and commissural distortion. Initial treatment included hydrogel and petrolatum dressings to allow autolytic debridement and better tissue demarcation. Definitive reconstruction was then performed. After escharectomy, a 3 × 1 cm full-thickness defect with orbicularis oris exposure remained. A whale-tail-shaped local mucocutaneous flap was raised from the adjacent cheek to restore muscular continuity, the mucocutaneous junction, the vermilion border, and the commissural angle. At 6 months, the patient showed preserved oral competence, adequate oral aperture, and satisfactory symmetry, with only mild residual asymmetry during mouth opening. Clinical discussion: Perioral electrical burns may appear limited in surface area but can result in full-thickness injury with major reconstructive implications. In this case, delayed reconstruction after short-term conservative wound care allowed better definition of viable tissue. The local flap provided like-with-like reconstruction in a single stage while avoiding prolonged splinting or staged procedures. Conclusion: When local tissue is preserved, a whale-tail-shaped mucocutaneous flap may offer effective single-stage reconstruction of acute commissural electrical burns in pediatric patients.