Skip to main content

Advertisement

Log in

Staged excision and split-thickness skin graft for circumferential perianal Paget's disease

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: This study was designed to describe a surgical technique for the treatment of circumferential Paget's disease. METHODS: A search of our computerized patient registry was undertaken, and case records for those patients with perianal Paget's disease were systematically reviewed. RESULTS: Between July 1993 and October 1998, four patients with perianal Paget's disease were identified. Circumferential lesions were identified in three of the four patients. Wide local excision was considered the procedure of choice. All patients underwent a two-staged excision using split-thickness skin graft reconstruction. A similar second stage was performed six to eight weeks later; the other half of the circumference was excised and grafted. No patient had a protective stoma. Graft survival was 100 percent for two patients (four operations) and 80 percent and 70 percent for the other two patients (two operations). The remaining surface healed successfully by secondary intention. In one patient, residual disease was positive at one margin, and a third local excision and split-thickness skin graft was performed. Hospital stay ranged from five to nine days for each procedure. There were no major complications; one patient developed a mild anal stenosis three months after the second procedure and was successfully medically treated. CONCLUSIONS: Staged excision and split-thickness skin graft is a viable option for the treatment of circumferential perianal lesions. It carries a minimal morbidity and no observed mortality, the functional result is good, and it is technically simple compared with myocutaneous grafts. Moreover, a stoma is not required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Sarmiento JM, Wolff BG, Burgart LJ, Frizelle FA, Ilstrup DM. Paget's disease of the perianal region—an aggressive disease? Dis Colon Rectum 1997;40:1187–94.

    Article  PubMed  Google Scholar 

  2. Besa P, Rich TA, Delclos L, Edwards CL, Ota DM, Wharton JT. Extramammary Paget's disease of the perianal skin: role of radiotherapy. Int J Radiat Oncol Biol Phys 1992;24:73–8.

    PubMed  Google Scholar 

  3. Brierly JD, Stockdale AD. Radiotherapy: an effective treatment for extramammary Paget's disease. J Clin Oncol 1991;3:3–5.

    Google Scholar 

  4. Thirlby RC, Hammer CJ Jr, Galagan KA, Travaglini JJ, Picozzi VJ Jr. Perianal Paget's disease: successful treatment with combined chemoradiotherapy. Report of a case. Dis Colon Rectum 1990;33:150–2.

    Article  PubMed  Google Scholar 

  5. Beck DE, Fazio VW. Perianal Paget's disease. Dis Colon Rectum 1987;30:263–6.

    PubMed  Google Scholar 

  6. Herzog U, Flue M, Foche R, Curschellas E. Perianal extramammary Paget's disease: report of two cases. Eur J Surg Oncol 1993;19:469–73.

    PubMed  Google Scholar 

  7. Murakami K, Tanimura H, Ishimoto K, Yamaue H, Yamade N, Shimamoto T. Reconstruction with bilateral gluteus maximus myocutaneous rotation flap after wide local excision for perianal extrammary Paget's disease. Dis Colon Rectum 1996;39:227–31.

    Article  PubMed  Google Scholar 

  8. Seckel BR, Schoetz DJ Jr, Coller JA. Skin grafts for circumferential coverage of perianal wounds. Surg Clin North Am 1985;65:365–71.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Supported in part by a research grant from the David G. Jagelman, M. D. Memorial Research Fund.

About this article

Cite this article

Lam, D.T.Y., Batista, O., Weiss, E.G. et al. Staged excision and split-thickness skin graft for circumferential perianal Paget's disease. Dis Colon Rectum 44, 868–870 (2001). https://doi.org/10.1007/BF02234711

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02234711

Key words

Navigation