Bilateral Lotus Petal Flap Repair for Perianal Paget’s Disease
Overview
A 65-year-old female with perianal Paget’s disease underwent wide local excision followed by bilateral lotus petal flap reconstruction. The procedure resulted in complete wound healing without flap compromise and preserved normal sphincter function at 3 months postoperatively.
Background
Perianal Paget’s disease is a rare intraepithelial adenocarcinoma presenting with erythematous plaques and scaling in the perineal and perianal regions. Surgical excision with clear margins is the mainstay of treatment, but reconstruction of the resulting defect can be challenging. The lotus petal flap, based on perforators of the internal pudendal artery, offers a reliable option for perianal reconstruction, preserving function and aesthetics.
Data Highlights
The patient underwent wide local excision with a 2 cm margin and bilateral fasciocutaneous lotus petal flap reconstruction. Postoperative follow-up at 3 months showed complete wound healing, no flap compromise, and normal sphincter function. A Foley catheter was maintained for 7 days postoperatively. No wound infection, breakdown, or hematoma was observed at 4 and 12 weeks.
Key Findings
Wide local excision included all visible perianal and posterior vulvar lesions with a 2 cm margin of healthy tissue.
Bilateral lotus petal flaps were designed over the medial thigh crease and rotated 90° to cover the defect.
Postoperative recovery was uneventful with complete healing and no flap compromise.
Normal fecal and urinary continence was preserved at 3 months follow-up.
No wound complications such as infection, breakdown, or hematoma occurred up to 12 weeks postoperatively.
Clinical Implications
The bilateral lotus petal flap is a viable reconstructive option after wide excision of perianal Paget’s disease, providing durable coverage while preserving sphincter function. Preoperative Doppler mapping aids flap design and vascular reliability. This technique can minimize postoperative complications and maintain continence, improving patient outcomes.
Conclusion
Bilateral lotus petal flap reconstruction following wide local excision is an effective and safe approach for managing extensive perianal Paget’s disease, ensuring complete healing and functional preservation.
