Abstract: Reconstruction of massive maxillofacial soft tissue defect needs free flap such as latissimus dorsi flap which can provide 20 cm×15 cm of soft tissue for repair. We reported a woman who presented with massive traumatic soft tissue defect with exposure of the skull, zygoma, and endocranium due to moyamoya disease history. She suffered from intracranial hemorrhage which caused neural damage and left limb dyskinesia. She underwent bilateral extracranial-intracranial bypass surgery. She was at risk of recurrent hemorrhage.We used free latissimus dorsi flap to reconstruct the defect successfully and avoided severe intracranial complication that might happen.

Key words: Soft tissue defect, Free latissimus dorsi flap, Moyamoya disease, Reconstruction