An interesting case of acne vulgaris complicating a free vascularized latissimus dorsi musculocutaneous flap used for heel reconstruction is presented. The development of acne in a free musculocutaneous island transfer has not been described before, and we speculate as to its cause. We conclude that quiescent donor site acne scarring may be a contraindication to the use of free skin flap transfer for soft tissue reconstruction.