Figure 1.

Planning schematic for the LD myocutaneous V-Y advancement flap depending on the thoracic defect location. From left to right: superior movement of the V-Y flap to incorporate as much of the LD muscle as possible and incising distally to mobilize the flap. Moving anteriorly, the flap is also incised distally and the end thirds of the flaps are raised and islanded on the LD centrally. Moving inferiorly, the flap is also incised distally with the skin island centered over the LD to incorporate as much of the LD muscle as possible. When mobilizing the flap medially (far right), the LD is incised proximally, unlike the others, to facilitate its movement toward the paraspinal region.