Amin et al. Head & Neck Oncology 2010, 2:18 http://www.headandneckoncology.org/content/2/1/18 Open Access CASE REPORT © 2010 Amin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Case report Living related hemi-face skin transplant using radial forearm free flap for a xeroderma pigmentosa patient: early outcome Ayman Amin* 1 , Mahmoud Bassiouny 1 , Kareem Sallam 1 , Galal Ghally 1 , Hanaa El-Karaksy 2 and Alaa El-Haddad 3 Abstract Introduction: Xeroderma pigmentosa (XP) is a hereditary disease characterized by deficient repair of DNA damage that occurred on exposure of the skin to ultraviolet irradiation. The affected children have a propensity to develop multiple skin cancers mainly in the face and eventually die before the age of 20. Hypothesis: Allograft replacement of facial skin by a healthy skin from normal person might decrease the incidence of skin cancer development, the number of surgical procedures, and eventually might improve the survival of these miserable patients. Methods: As Cadaveric organs are unavailable in our country. After approval from the ethical committee, confirmed agreement of the donor and the patient's guardian, a radial forearm free flap was transplanted from an ABO compatible mother to her 5 year old daughter with XP. The mother had an older daughter died from the same disease at the age of 14. The flap replaced skin of the hemi face that developed precancerous lesions. The girl was kept on adjusted doses of immunosuppressive drugs. Results: The flap survived, wounds healed uneventfully. The flap developed a reddish spot one and half month following transplant where baseline skin biopsy was taken. In the fifth months the girl presented with bad non salvageable rejection that ended up loosing the flap. On long term follow up, the girl started to develop skin lesion on the virgin half of the face. Our early cosmetic result replacing half of the facial skin was very promising. In addition the girl did not develop skin lesions in the operated site. Conclusion: Our early cosmetic result was very promising. In addition to this, the girl did not develop skin lesions in the operated side of the face Introduction Xeroderma pigmentosa (XP) is an autosomal recessive genetic disorder that makes the DNA of the skin unable to repair the continuous damage inflicted on it by the Ultra Violet (UV) rays present in sun rays [1]. A dominant form of XP was described in a Scottish girl; these patients have a mild clinical course [2]. The disease is character- ized by photosensitivity, pigmentary changes, premature skin ageing, neoplasia and abnormal DNA repair. Some patients also have neurological complications. Affected individuals are 1000 times more prone to UV induced skin cancer than unaffected ones and over 90% of affected individuals will develop skin malignancy before the end of their second decade [3]. Development of multiple recurrent skin malignancy is the eventual outcome of this DNA repair failure which world-wide kills two thirds of the affected subjects before the age of 20. Death follows a lengthy devastating illness for both the patient and his family where malignant lesions can develop as early as the third or fourth year [2]. During their life span they get exposed to repeated surgical resection of newly-devel- oped skin cancers. Surgical resection ranges from simple excision and skin closure to heroic cranio-facial resection and free flap reconstruction. In a desperate attempt to prevent malignant transfor- mation, affected individuals have to be kept away from sun light through out there life. There is no definitive * Correspondence: aymanamin@hotmail.com 1 Surgical oncology department, national cancer instituite, Cairo, Egypt Full list of author information is available at the end of the article