Elevation of the skin along with its deep fascia vascular network is a recent facility for flap design. The longitudinal trapezius fasciocutaneous flap was first introduced in 1996; at that time it did not receive much attention, although it has many significant benefits compared with other available procedures. Sixteen trapezius fasciocutaneous flaps were elevated in 15 patients for reconstruction of severe scarring of the neck and midface. All flaps were based on the deep branch of the transverse cervical artery and included the overlying fascia of the trapezius muscle. Delaying was applied for very long flaps. Two flaps developed minimal distal necrosis (<5 cm) due to longer pedicles (>10 cm below the muscle border). The results indicate that an extra-long back fascia flap based on the descending branch of the transverse cervical artery could be formed, which would be long enough to reconstruct the entire neck and safely transfer it to the midface. The vertical trapezius fasciocutaneous flap, with its abundant tissue, excellent blood supply, anatomic proximity, wide arc of rotation, and hidden donor site scar, provides a simple and reliable method for primary reconstruction of various midface and neck defects.