The neuromuscular pedicle of the trapezius is shown. The blood supply arises from the thyrocervical branch of the subclavian artery and passes over the brachial plexus to divide into ascending and descending branches on the undersurface of the trapezius near the cephalad end of the muscle.
First, the previous wound is excised with a 10-blade, rongeur, and curette through the previous granulation tissue. The wound is debrided, irrigated with sterile saline solution and Bacitracin, and left covered with a wet lap soaked in antibiotics while the flap is dissected.
The preoperatively demarcated area is confirmed using a handheld Doppler to locate perforators overlapping the trapezius muscle, which are marked. The marking for the flap is reoriented to include the selected perforators.
To begin the trapezius flap dissection, the outlined flap is incised with a 10-blade and dissected with Bovie electrocautery until the latissimus dorsi is identified visually. The dissection is continued medially until the trapezius is found.
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