The cervicohumeral flap is based on the posterior shoulder and supraclavicular region, extends across the acromioclavicular joint, and continues down the lateral aspect of the arm (Fig. 134.1). The axis of rotation, and presumably the blood supply, is the trapezius muscle (3, 4). The dominant vascular pedicle to the trapezius is the transverse cervical artery, although branches (probably minor in significance) are contributed by the occipital artery proximally, the superficial cervical artery in the midportion of the muscle, and branches of the suprascapular in the distal portion (3).

Beyond the distal insertion of the trapezius, the skin over the deltoid on the lateral proximal arm is supplied by the posterior circumflex humeral artery. This skin, when included with the trapezius musculocutaneous unit and with sacrifice of the posterior circumflex humeral artery, is random in blood supply. The skin distal to the insertion of the deltoid probably is derived from the lateral head of the triceps and the biceps-triceps intermuscular septum (5).

The cervicohumeral flap has been described as reliable when raised undelayed with a length-width ratio of 3:1. The flap has been centered over the acromioclavicular joint and extended down the anterolateral arm. On occasion, the flap has been extended to a distance of 30 cm, although not with consistent success.