Vascularized nerve transplants can lead to satisfactory functional reconstruction for nerve defects. These include defects following traumatic nerve severance, iatrogenic severance during tumour resection and extensive defects in poorly vascularized transplant sites. No previous description of the long thoracic nerve as a vascularized nerve graft is available. The aim of this study was to demonstrate the anatomic and initial clinical application of such a graft. The long thoracic nerve was dissected in 84 cases to examine its length, diameter, ramification and type of perfusion. On removal of the nerve, adequate perfusion through the thoracodorsal artery and a constant anatomic course with minimal loss of function were found. The long thoracic nerve is accessible anatomically, easily dissected and removed. This may be carried out together with the thoracodorsal vein and artery and even with a pedicled myocutaneous latissimus dorsi transplant, an osseo-myocutaneous scapulo-latissimus dorsi transplant or an osseous scapular transplant. The long thoracic nerve transplant can be employed for extensive facial defects together with simultaneous osseous and myocutaneous transplants of the shoulder region.