Trigeminal neuralgia, trophic ulceration and the plastic surgeon

An 80-year-old woman presented with ulceration to the right alar margin about 20 years after first undergoing treatment for trigeminal neuralgia. This was reconstructed with a sensory innervated left nasal flap. Two years later she required an innervated left forehead flap to correct a secondary ectropion of the right lower eyelid, and the following year required further surgery to repair a defect on her chin. Cosmesis remains satisfactory with no further ulceration 2 years after the last operation.