Fig 3.

The patient is positioned in the left lateral decubitus position with the right upper extremity draped onto a limb positioner to keep the arm abducted and internally rotated. (A) The skin is marked along the posterior axillary fold with the incision along the humerus corresponding to the exposure for the humeral footprint (red arrowhead) and the inferior aspect of the incision along the posterior chest wall (white arrowhead) is for retrieval of the retracted latissimus tendon and can be extended as needed. (B) Retractors are used to tension the skin as dissection continues through the soft tissues down to fascia. A mixture of sharp and blunt finger dissection is used in between the pec major and triceps to identify the latissimus tendon. (C) A seroma cavity can be encountered (blue arrow) as dissection continues near the tendon stump. (D) As dissection proceeds toward the humerus, branches of the posterior brachial cutaneous nerve (white arrow) are identified and protected as they lay over the triceps. (PBCN, posterior brachial cutaneous nerve.)