Patients that have undergone previous laryngectomy with permanent stoma placement are at increased risk of wound infection, mediastinitis, and tracheal injury when undergoing coronary artery bypass grafting (CABG) via standard skin incision and sternotomy. We present a case of off-pump CABG via a low midline skin incision with transverse skin flaps and a manubrium sparing sternotomy. doi: 10.1111/jocs.12771 (J Card Surg 2016;31:439–440).