Super-Thin ALT Flap for Composite Nasal Reconstruction in an Elderly Kidney Transplant Patient

Nasal reconstruction is one of the most challenging procedures in plastic surgery, requiring restoration of the three-dimensional structure, precise contour, internal lining, and airway function. These challenges are further amplified when traditional donor sites are unavailable, particularly in elderly patients or those undergoing concomitant treatments. We report the case of a 78-year-old man on immunosuppressive therapy following kidney transplantation, presenting with recurrent basal cell carcinoma affecting the middle and lower thirds of the nose. After tumor excision resulting in a 7 × 5 cm defect, and given the patient's characteristics and limitations of conventional options, a customized super-thin anterolateral thigh (ALT) flap (7 × 16 × 0.8 cm) combined with nasal septal and auricular cartilage grafts was chosen for reconstruction. Postoperative recovery was uneventful, and at 6 months, the patient demonstrated normal nasal contour, an open airway, and no signs of recurrence. Despite inherent limitations related to skin and subcutaneous tissue quality and thickness, a super-thin ALT flap may represent a reliable single-stage alternative for total nasal reconstruction in selected high-risk patients.