Research Article| Volume 60, ISSUE 11, P1208-1213, November 2007

Functional reconstruction of large anogenital defects with bilateral V–Y advancement posterior thigh fasciocutaneous flaps

Published:April 05, 2007DOI:



      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.


      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.


      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.


      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.


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        • Terashi H.
        • Shibata O.
        • Yamamoto A.
        • et al.
        V-Y advancement posterior thigh fasciocutaneous flaps for total anal canal and large perianal defects.
        Ann Plast Surg. 1996; 37: 340-341
        • Core G.B.
        • Bite U.
        • Pemberton J.H.
        • et al.
        Sliding V-Y perineal island flaps for large perianal defects.
        Ann Plast Surg. 1994; 32: 328-331
        • Sasaki K.
        • Nozaki M.
        • Kikutchi Y.
        • et al.
        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
        • Jones Jr., R.E.
        • Austin C.
        • Ackerman A.B.
        Extramammary Paget's disease. A critical reexamination.
        Am J Dermatopathol. 1979; 1: 101-132
        • St Peter S.D.
        • Pera M.
        • Smith A.A.
        • et al.
        Wide local excision and split-thickness skin graft for circumferential Paget's disease of the anus.
        Am J Surg. 2004; 187: 413-416
        • Beck D.E.
        • Fazio V.W.
        Perianal Paget's disease.
        Dis Colon Rectum. 1987; 30: 263-266
        • Murakami K.
        • Tanimura H.
        • Ishimoto K.
        • et al.
        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
        • McCraw J.B.
        • Massey F.M.
        • Shanklin K.D.
        • et al.
        Vaginal reconstruction with gracilis myocutaneous flaps.
        Plast Reconstr Surg. 1976; 58: 176-183
        • Rubin J.A.
        • Whetzel T.P.
        • Stevenson T.R.
        The posterior thigh fasciocutaneous flap: vascular anatomy and clinical application.
        Plast Reconstr Surg. 1995; 95: 1228-1239
        • Hurwitz D.J.
        • Swartz W.M.
        • Mathes S.J.
        The gluteal thigh flap: a reliable, sensate flap for the closure of buttock and perineal wounds.
        Plast Reconstr Surg. 1981; 68: 521-532
        • Rao S.S.
        Pathophysiology of adult fecal incontinence.
        Gastroenterology. 2004; 126: S14-S22
        • Pescatori M.
        • Ayabaca S.
        • Caputo D.
        Can anal manometry predict anal incontinence after fistulectomy in males?.
        Colorectal Dis. 2004; 6: 97-102
        • Laurberg S.
        • Swash M.
        Effects of aging on the anorectal sphincters and their innervation.
        Dis Colon Rectum. 1989; 32: 737-742