Nasal Ala Reconstruction with Mid-Forehead Flap in a Patient with Xeroderma Pigmentosum: a Case Report

Xeroderma pigmentosum (XP) is a disease characterized by a high sensitivity to sunlight, resulting in burns, changes in skin pigmentation, and a significantly higher incidence of skin neoplasms. The nose is the most affected area by non-melanoma skin cancer in such patients. The surgical approach to skin tumors can become quite challenging depending on the stage of the disease, the location of cancer, and, in a patient with XP, it is necessary to use healthy skin for reconstruction. The present work intends to show a case in which a mid-forehead flap was used to reconstruct the nasal wing after the excision of a tumor in a patient with XP. Patient with XP and skin tumor on the right nasal wing and nasal tip, compatible with non-melanoma skin tumor. He underwent resection of the tumor with safety margins by the oncological surgery service on September 30, 2019. He evolved hemodynamically stable. In the following month, he sought the plastic surgery service of the Hospital Universitário Walter Cantídio for nasal reconstruction. He was admitted to the inpatient unit on October 8 and underwent nasal reconstruction with a mid-forehead flap, nasal cartilage, and enlarged margins of the right infrapalpebral skin lesion, evolving without complications. The case presented here is interesting given the difficulty of reestablishing the integrity of the region since the options for healthy skin in a patient with XP are scarce. Therefore, not only the type of flap, but also the technique to be used must be very well planned and, with that, a satisfactory aesthetic and functional result can be reached.