I think this is one of the reasons why macro works so well with large format. Camera movements allow you to adjust the plane of focus in order to maximize the focus on the subject of interest. A good monorail will allow virtually unlimited bellows draw along with movements that would make a pretzel envious. Focusing in the 3-4x range should be a snap.
Some macro bellows for 135 cameras have front swings and tilts. IIRC, at least couple offer them on back too.