Functional reconstruction of large anogenital defects with bilateral V-Y advancement posterior thigh fasciocutaneous flaps.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Fujii
Miki
M
Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. fjimk@med.kobe-u.ac.jp
Terashi
Hiroto
H
Hashikawa
Kazunobu
K
Tahara
Shinya
S
D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery* / Q000637:transplantation; D003672:Defecation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D010145:Paget Disease, Extramammary / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods / Q000534:rehabilitation; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome