Fig. 5

Intraoperative findings in case 2. a The schema shows the arteries and veins of the operative site. The interrupted lines show the sacrificed vessels, including the internal thoracic artery and vein, subclavian vein, and brachiocephalic vein. b Right anterior oblique view of the operation. The anterior surface of the trachea can be seen, as the thyroid gland had been entirely removed. The right sternocleidomastoid muscle was reconstructed to cover the arteries and veins of the neck while two suction drains were placed under the muscle. c The design of the DP flap was drawn in the usual manner. The distal edge was extended to the mid-lateral line of the shoulder. d The deltoid muscle and the pectoralis major muscle are observed after DP flap setting. Airtight conditions were ensured to maintain efficacy of the suction drains. e Split thickness skin grafting was performed to the donor site of the DP flap. The skin graft had been processed using a mesh dermatome to fit the uneven surface of the muscle and fatty tissue