Fig. 1.

Preoperative design of the LTMC flap

A Doppler ultrasound was used to trace the transverse cervical artery (TCA) and the dorsal scapular artery (DSA). The pedicle of the lower trapezius musculocutaneous (LTMC) flap is the DSA. The muscle margins, the medial border of the scapula, and the thoracic spine down to the twelfth vertebra are marked on the back (line T). One-third of the skin island must be over the trapezius muscle and should not be extended more than 10 cm distal to the inferior angle of the scapula (line S).