Accidental reinnervation as a complication of latissimus dorsi free flap to the face and scalp

Abstract

Although direct nerve neurotization is well known, accidental full reinnervation of a major muscle following microvascular transfer has not previously been reported. Our patient, who presented with total scalp loss, was initially treated with simple skin grafts. Repeated breakdowns over the years necessitated the use of more durable cover. A free latissimus dorsi muscle flap achieved this objective. Two years post-transfer it became evident that the whole of the latissimus dorsi had become innervated, producing facial and scalp distortion when the patient smiled. Formal exploration and section of both neural trunks to the latissimus dorsi was necessary to abolish this bizarre grimace.