title: Long-term functional and quality of life outcomes of patients after repair of large perianal skin defects for Paget's and Bowen's disease.
abstract: BACKGROUND
  The assessment of long- term functional and quality of life outcomes of these patients following repair of large defects after surgical excision has not been reported.
  
  
  METHODS
  Between 1992 and 2004, at two institutions, 18 patients underwent repair of a perianal defect for Paget's disease (n = 8) or Bowen's disease (n = 10) and were alive with intestinal continuity at last follow-up. Patients were mailed the fecal incontinence quality of life scale (FIQL) and the SF-36.
  
  
  RESULTS
  Fourteen patients (78%) responded. Median follow-up for responders was 5 years. Mean age was 65 years with 12 females. Subcutaneous skin flaps (11) and split-thickness skin grafts (three) were used to repair the perianal defects, which were circumferential in 11 patients (79%). Nine patients reported incontinence and completed the FIQL. The FIQL scores of patients reporting incontinence were lower for lifestyle, coping/behavior, and embarrassment but not significantly different for depression compared to patients without incontinence. SF-36 scores of the patients were not significantly different from the normative population.
  
  
  CONCLUSIONS
  Functional results after repair of large perianal defects are acceptable and overall quality of life (QOL) is similar to the normative population although a large proportion of patients have some form of incontinence that impacts certain aspects of their QOL.
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62704, USA.
authors.forename: Alissa
authors.initials: A
authors.lastname: Conklin
authors.forename: Imran
authors.initials: I
authors.lastname: Hassan
authors.forename: Heidi K
authors.initials: HK
authors.lastname: Chua
authors.forename: E Dawn
authors.initials: ED
authors.lastname: Wietfeldt
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Larson
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Thomsen
authors.forename: Sanhat
authors.initials: S
authors.lastname: Nivatvongs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001913:Bowen's Disease / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D020127:Recovery of Function; D012878:Skin Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome