A Case Report of Perianal Paget's Disease Successfully Treated with a Wide Excision and Posterior Femoral V-Y Flap Reconstruction

Kentaro Kawasaki¹⁾²⁾, Hirokazu Ohno³⁾, Daisuke Tsugawa¹⁾, Shiro Takase¹⁾, Takashi Kamigaki¹⁾, Daisuke Kuroda¹⁾, Hajime Ikuta⁴⁾ and Yoshikazu Kuroda¹⁾

Division of Gastroenterological Surgery, Department of Clinical Molecular Medicine,
Graduate School of Medical Sciences, Kobe University¹⁾
Department of Endoscopic Diagnostics and Therapeutics, Kobe University²⁾
Division of Surgery, Konan Kakogawa Hospital³⁾
Division of Surgery, Kasai City Hospital⁴⁾

We report a case of perianal Paget's disease with preoperative SNB, resected curatively, reconstructed with a V-Y skin flap, and preserved anal function. A 82-year-old woman reporting perianal itching and redness was referred with a diagnosis of Paget's disease. The lesion was 16×15 cm. Preoperative pelvic computed tomography (CT) showed bilateral inguinal lymph node swelling, necessitating sentinel lymph node biopsy (SNB) using 99m-Tc. The result of the biopsy was negative. We determined the resection line by preoperative mapping, conducting a wide excision while maintaining a 2 cm safety margin around the main lesion, and constructing a temporary stoma. We then conducted V-Y skin flap reconstruction using bilateral posterior femoral skin. Six months later, we closed the colostomy. Anal function has been preserved.

Key words
perianal Paget, V-Y skin graft, sentinel lymph node biopsy

Reprint requests
Kentaro Kawasaki Division of Gastroenterological Surgery, Department of Clinical Molecular Medicine, Graduate School of Medical Sciences, Kobe University
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JAPAN

Accepted
March 22, 2006

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