A Case of Perianal Paget's Disease Successfully Treated with a Wide Excision and Gluteal Fold Flap Reconstruction

It is important to avoid contracture of the skin flaps and subsequent anal stricture when a wide local excision is conducted in patients with perianal Paget's disease. We report such a case treated with a wide excision followed by reconstruction using gluteal fold flaps for the perianal defect. An 83-year-old woman with perianal Paget's disease underwent resection of the 14cm×10cm affected skin lesion, keeping free margins at least 3 cm from the macroscopic border of the lesion. Gluteal fold flaps 4cm×9cm and 4cm×8cm based on perforators of the perineal artery were used to reconstruct the defect. Diverting colostomy concomitantly created was closed 3 months postoperatively. The patient is alive without recurrence or deteriorated anal function 26 months following after initial surgery. Our procedure is thus useful in patients with extensively spreading perianal Paget's disease.