Omocervical axial rotating skin flap

Axial flaps are used when there is not enogh skin to close a large defect. This omocervical axial flap incorporates the superficial cervical branch of the omocervical artery and vein. The vessels originate adjacent to the prescaplar lymph node and arborize dorsally, cranial to the scapula.
At the first step a line is drawn over the spine of the scpula with a marking pen to mark the caudal border of the flap. Then the cranial border is drawn parallel to the caudal line, just cranial to the shoulder depression.
In the picture below the borders of the flap are marked,.

The next picture shows a large mass to be removed from the axillary area

The next picture shows a large defect after the mass has been removed. This large defect cannot be closed routinely

The next picture shows  the axial flap being elevated. In order to rotate the flap the cranial incision is continues towards the defect to be covered, and the tissue connecting this border to the acudal border of the flap is undermined, and the flap is released cranially while staing attached at the distal part of the caudal border. This area of attachement is the base of the flap that can now be rotated in order to cover the axillary defect.

The donor site is sutured

The flap is sutured to the defect via subcuticular sutures, and skin sutures. A drain is placed due to the dead space.