Remove the skin and superficial fascia from the back and shoulders along the following (approximate) lines.
- Midline from spinous process C7 to the level of the iliac crest
- From the inferior limit of the midline incision to the midaxillary line (both sides)
- From spinous process C7 to the acromion process (both sides)
- From the acromion process to a line encircling the arm at the level of the deltoid tuberosity (both sides)
- Connect the incision encircling the arm with the incision along the midaxillary line