when microvascular option is not available or contraindicated the pedicle options are usually pectoralis major myocutaneous ( pmmc ) flap for lining and deltopectoral ( dp ) flap for cover . if this procedure can be done in a single stage it becomes advantageous both for the patient in terms of reducing the morbidity , total cost , hospital stay and to the surgeon with no microvascular expertise . the idea is to transpose a medially based platysma myocutaneous neck flap , to cover the cheek defect after it has been lined by pmmc flap . the resultant neck defect after elevation of neck flap is covered by transposing a dp flap to the neck . we are describing the procedure in a 43-year - old female patient with squamous cell carcinoma of right side buccal mucosa with skin involvement and ulcerating neck node [ figure 1 ] . a medially based platysma myocutaneous flap was planned so as to cover the skin defect of cheek comfortably . the onco surgeon then proceeded with the neck dissection , which was already bare after elevation of the platysma myocutaneous flap followed by excision of the tumour . the residual neck skin over which the dp flap is going to sit was marked and elevated as a laterally based platysma myocutaneous flap and transposed to the dp area . preoperative photograph showing ulcerated carcinoma cheek with ulcerating neck node intraoperative photograph showing planning of the flaps - medially based platysmal myocutaneous flap ( a ) , laterally based platysmal myocutaneous flap ( b ) , deltopectoral flap ( c ) and pectoralis major myocutaneous flap ( d ) showing planning of flaps ( a ) medially based platysmal myocutaneous flap ( b ) laterally based platysmal myocutaneous flap ( c ) deltopectoral flap and pectoralis major ( d ) myocutaneous flap intraoperative photograph showing the inset of the flaps into their respective positions with skin - grafted chest wall ( flap d is used for lining and hence not seen in the picture ) eighth day postoperative photograph of the same patient , showing well settled medially based platysmal myocutaneous flap ( a ) , laterally based platysmal myocutaneous flap ( b ) and deltopectoral flap ( c ) the patients with conventional dp flap usually do not leave the hospital till flap detachment and final inset . hence the hospital stay is significantly reduced with this procedure . during the second stage , some surgeons prefer to excise the bridge segment , which leaves a large skin grafted area on chest which is not aesthetic . skin graft requirement is less ( approximately 20% ) than a conventional dp since part of the pectoral area is covered by the laterally based cervical flap . by the same logic overall cost associated with a double procedure and longer stay is also avoided . for the onco surgeon , the neck dissection is easier with an elevated platysma myocutaneous flap leaving a bare neck . since the length of the dp flap to reach the neck is shorter than a cheek defect , it is more reliable . there is no doubting the fact that free tissue transfer is superior to this technique . but this flap comes in the armamentarium when the logistics do not favour a free flap . this is aesthetically superior to a double paddle pmmc and more so in a female patient where the flap is very bulky . forehead flap is also an option where lining and cover can be provided but it is aesthetically not appealing for obvious donor site deformity . providing cover with a cervicothoracic flap is another option but it is cumbersome to raise such a huge flap as a single unit . our technique splits this single cervicothoracic unit into three units which allows a better positioning of regional tissue units . the plastic surgeon has to precisely plan and raise the neck flap prior to the onco procedure so as allow the onco surgeon access to the neck . in patients with normal neck skin , a part of it is sacrificed near its base to avoid dog ear , which was not the case with this patient since she had an ulcerating neck node . this technique offers an alternative to single - staged microvascular procedure and is superior to double - paddle pmmc or conventional dp with pmmc for classical lining and skin defects .