Figure 2

Elevation of the flap: The flap is elevated deep to the fascia of the pectoralis major muscles, with dissection proceeding inferiomedially. Elevation above the clavicle is in a subplatysmal plane, including the superficial layer of the deep cervical fascia. Once elevation has been completed, the flap is rotated in a superior and medial direction to cover the defect in a tension-free manner.