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PLATE XII-1. Anatomy
 A. The flap is outlined over the central portion of the scapula, more or less perpendicular to its long axis. The base of the flap overlies the triangular space, which can be visualized just above the point where the long head of the triceps passes deep to the teres major and latissimus dorsi muscles. A Doppler probe can be used to help localize this point where the cutaneous vessels penetrate the skin. The flap can extend anteriorly to the posterior axillary fold and posteriorly to within 3 or 4 cm of the midline. It extends superiorly to the spine of the scapula down to within a few centimeters of the angle of the scapula. The major axis of the flap can also be oriented in vertically paralleling the axis of the scapula. Both transverse and vertical flaps can be raised as a single bilateral flap with or without the vascularized underlying lateral scapular border.
PLATE XII-2
 A. Elevation of the flap proceeds from the midline laterally. The dissection is performed between the multiple fascial layers in the plane superficial to the rhomboid muscles and the scapular muscles. The deep fascia does not usually need to be stripped from the underlying muscle. As the base of the flap is approached, transillumination and the Doppler probe are helpful in delineating the vessels.
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 B. The vascular pedicle has now been completely isolated as it enters the triangular space. The descending branch of the scapular circumflex can be tied to gain additional length. The dissection can be carried into the axilla proximally on the subscapular artery all the way up to the axillary artery itself. Multiple microvascular branches to the muscles surrounding the triangular space must be ligated to extend the pedicle. The flap can be passed through the triangular space and, on this long vascular pedicle, can be transferred to the anterior part of the chest or shoulder as an intact flap similar to the latissimus dorsi myocutaneous flap.
 C. The flap has been further elevated by tying the descending portion of the subscapular artery. As pointed out in the text, flaps as wide as 10 cm in diameter can be closed primarily, producing a transverse linear scar for a defect. If this area must be grafted, the donor defect is much less acceptable.
PLATE XII-3
 A. The pedicle can be mobilized further through the triangular space by tying off the circumflex scapular descending branch and various muscular branches.
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