Summary
Background
In patients with perianal extramammary Paget's disease, wide local excision is recommended.
In the reconstruction of the resulting large defects not only the closure of the defect
but also the preservation of anogenital function need to be considered.
Methods
We used bilateral V–Y advancement posterior thigh fasciocutaneous flaps for reconstructing
three large anogenital defects, including the total anal canal, resulting from wide
local excisions attributed to extramammary Paget's disease. A temporary anus was constructed
at the same time to allow the wound of the reconstructed anus to heal. After the surgery,
the course of bowel function was followed up through interviews and manometric examinations.
Results
All defects were successfully reconstructed with the flaps, and bowel function recovered
satisfactorily. Manometric examinations were carried out in two cases; anal pressures
were recorded regularly and used as parameters of the recovery of bowel function before
closing the artificial anus. Eventually, the patients recovered the function of defecation.
Conclusions
We recommend the bilateral V–Y advancement posterior thigh fasciocutaneous flaps together
with manometric studies as one of the most effective techniques for managing large
anogenital defects. The use of sensate flaps, the restoration of original structures
and manometric studies are conducive to successful outcomes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- V-Y advancement posterior thigh fasciocutaneous flaps for total anal canal and large perianal defects.Ann Plast Surg. 1996; 37: 340-341
- Sliding V-Y perineal island flaps for large perianal defects.Ann Plast Surg. 1994; 32: 328-331
- Reconstruction of perianal skin defect using a V-Y advancement of bilateral gluteus maximus musculocutaneous flaps: reconstruction considering anal cleft and anal function.Br J Plast Surg. 1999; 52: 471-475
- Extramammary Paget's disease. A critical reexamination.Am J Dermatopathol. 1979; 1: 101-132
- Wide local excision and split-thickness skin graft for circumferential Paget's disease of the anus.Am J Surg. 2004; 187: 413-416
- Perianal Paget's disease.Dis Colon Rectum. 1987; 30: 263-266
- Reconstruction with bilateral gluteus maximus myocutaneous rotation flap after wide local excision for perianal extramammary Paget's disease. Report of two cases.Dis Colon Rectum. 1996; 39: 227-231
- Vaginal reconstruction with gracilis myocutaneous flaps.Plast Reconstr Surg. 1976; 58: 176-183
- The posterior thigh fasciocutaneous flap: vascular anatomy and clinical application.Plast Reconstr Surg. 1995; 95: 1228-1239
- The gluteal thigh flap: a reliable, sensate flap for the closure of buttock and perineal wounds.Plast Reconstr Surg. 1981; 68: 521-532
- Pathophysiology of adult fecal incontinence.Gastroenterology. 2004; 126: S14-S22
- Can anal manometry predict anal incontinence after fistulectomy in males?.Colorectal Dis. 2004; 6: 97-102
- Effects of aging on the anorectal sphincters and their innervation.Dis Colon Rectum. 1989; 32: 737-742
Article info
Publication history
Published online: April 05, 2007
Accepted:
February 11,
2007
Received:
July 19,
2006
Footnotes
☆Presented in part at the 48th Annual Meeting of the Japanese Society of Plastic and Reconstructive Surgery, Tokyo, Japan, April 13–15, 2005.
☆☆No conflicts of interest or commercial relationships exist and no special funding has been provided for this work.
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
