2010 Volume 43 Issue 1 Pages 112-117
A 70-year-old woman referred for surgery due to extramammary perianal Paget's disease diagnosed by a skin biopsy had a widespread perianal lesion indicating possible direct invasion of the anal canal and rectal mucosa. Preoperative colonoscopy and mapping biopsies showed no direct invasion, however, so we chose wide local excision and simultaneous split-thickness skin grafting from the right posterior thigh to preserve anorectal function. At anal canal, external and internal sphincter muscles were preserved and submucosa was dissected upward 1 cm above the dentate line. Distal rectal mucosa was sutured directly at the external sphincter muscle while preserving a safety margin of 2 cm. Her postoperative course was uneventful despite slight postoperative soiling, and no anal stricture developed. She is now doing well 1.5 years after the operation. Wide local excision and split-thickness skin grafting thus achieved good functional results without a diverting colostomy, contributing to QOL in such patients.
