In many situations the head and neck surgeon is forced to excise large areas of tumor bearing skin in the lateral head and neck regions. This skin, either containing primary malignancies or tumors arising from underlying structures (such as lymph nodes, the mandible or the parotid gland), often is heavily irradiated. Consequently, free full-thickness skin grafts have limited chance of survival because of the reduced blood supply of the adjacent tissue. In these cases we use the so-called shoulder flap, as first described by Conley, to cover large defects. This flap, bases between the trapezius muscle and the scapula, has a rich blood supply, closes the defects in one stage and avoids restriction of the head. In addition, the donor site can be closed transposition of adjacent skin when possible without functional defect. Nine clinical cases are presented.