Starting distally and laterally, the myocutaneous trapezius flap is elevated in a medial, superior direction along with the perforators, which are located in the proximal aspect of the flap. The island flap is dissected starting caudally because the blood supply is located through the superior end of the flap.
The trapezius is partially divided laterally and medially in order to allow for flap rotation, with the goal of obtaining a good rotation with wound coverage without any tension.
For inferior trapezius island flaps, such as this one, the branch of the dorsal scapular artery must be protected by dividing the rhomboid minor vessel to allow for proper rotation of the vessels. The blood supply to the trapezius muscle predominantly comes from the thyrocervical trunk with the deep branch of the transverse cervical artery and vein running through the dominant pedicle.
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