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The knowledge of anatomy acquired at the university level carries surgeons through most of their careers. However, it is important to be aware of uncommon anatomical variants when performing surgery. The authors describe a case involving three anatomical variants found in three different anatomical locations in a single patient during one operative episode. These included Langer's muscle, transjugular course of the spinal accessory nerve and unusual layout of the femoral vessels at the inguinal ligament. While cadaveric studies report an incidence of up to 7% for the anomaly of the latissimus dorsi muscle, and up to 1% to 3% for a transjugular accessory nerve, clinical experience suggests that it is considerably rarer and can surprise even experienced surgeons. The wary surgeon, having identified one anomaly in their patient, will be mindful that there may be others.

plastic surgery case studies

Multiple Concomitant Anatomical Variants Challenging Synchronous Neck and Axillary Lymphadenectomy and Latissimus Dorsi Flap Reconstruction in a Patient with Malignant Melanoma