Clinical Scorecard: Bilateral lotus petal flap repair in the treatment of perianal Paget’s disease
At a Glance
Category
Detail
Condition
Perianal Paget’s disease presenting as erythematous plaques with white scaling in perineal, vulvar, and perianal regions
Key Mechanisms
Wide local excision of lesions with 2 cm margin followed by bilateral lotus petal fasciocutaneous flap reconstruction based on internal pudendal artery perforators
Target Population
Patients with extensive perianal Paget’s disease requiring surgical excision
Care Setting
Multidisciplinary institutional surgical setting with postoperative follow-up
Key Highlights
Wide local excision including all visible lesions with 2 cm margin of healthy tissue
Bilateral lotus petal flaps elevated from medial thigh crease and rotated 90° to cover perianal defect
Postoperative outcomes showed complete wound healing, preserved sphincter function, and no flap compromise at 3 months
Guideline-Based Recommendations
Diagnosis
Skin biopsy to confirm Paget’s disease in erythematous plaques with scaling
Management
Wide local excision of all visible lesions with adequate margins
Bilateral lotus petal flap reconstruction planned using handheld Doppler ultrasound to identify internal pudendal artery perforators
Use of Foley urinary catheter for 7 days postoperatively
Monitoring & Follow-up
Postoperative follow-up to assess wound healing, flap viability, and sphincter function at 4 and 12 weeks
Risks
Potential risks include wound infection, flap compromise, wound breakdown, hematoma, and sphincter dysfunction
Patient & Prescribing Data
65-year-old female with perianal Paget’s disease and extensive lesions
Surgical excision with bilateral lotus petal flap reconstruction resulted in uneventful recovery and preserved continence
Clinical Best Practices
Preoperative flap planning with handheld Doppler ultrasound to identify perforators
Ensuring 2 cm margin of healthy tissue during excision to reduce recurrence risk
Careful mobilization of urethra and exposure of perineal muscles and external anal sphincter during surgery
Postoperative catheterization for urinary management
Close follow-up to monitor wound healing and functional outcomes
