Wide local excision and split-thickness skin graft for circumferential Paget's disease of the anus.
Document Type
Article
Publication Date
3-1-2004
Identifier
DOI: 10.1016/j.amjsurg.2003.12.021
Abstract
BACKGROUND: Our aim was to evaluate the results of wide local excision followed by split-thickness skin graft for circumferential perianal Paget's disease.
METHODS: Between 1995 and 1999, 5 patients with perianal Paget's disease underwent wide local excision of the disease. The circumferential involvement was documented by preoperative mapping. Standard orthograde bowel cleansing and oral antibiotics were given the day prior to surgery. The wound was allowed to granulate and confirmation of negative margins was obtained on permanent sections taken from the excised specimens. On postoperative day 4, split-thickness skin grafts harvested from the lateral thigh were applied (surface using area ranging from 100 cm(2) to 240 cm(2)). The grafts were secured in place with a 3-0 Vicryl suture and covered with a pressure dressing. After 4 days of bedrest, the dressing was taken down under anesthesia (day 8).
RESULTS: Graft survival was 100% in 3 patients, 80% in 1 patient, and 70% in another. Postoperatively, clinical follow-up was conducted at 3-month intervals. In 2 patients, anal stenosis developed after the operation and resolved by gentle self-dilation. At a mean follow-up of 42 months (range 21 to 78), adequate cosmetic and functional results were obtained. Recurrence of Paget's disease has occurred in 1 patient (at 21 months) and an invasive anal gland carcinoma was found in 1 patient (at 48 months).
CONCLUSIONS: Wide local excision and circumferential split-thickness skin grafting achieves adequate cosmetic and functional results without the need for diverting colostomy. However, there is a considerable recurrence rate after surgery, which warrants very close follow-up to rule out recurrent disease or underlying adenocarcinoma.
Journal Title
American journal of surgery
Volume
187
Issue
3
First Page
413
Last Page
416
MeSH Keywords
Aged; Aged, 80 and over; Anus Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Middle Aged; Paget Disease, Extramammary; Reconstructive Surgical Procedures; Risk Assessment; Sampling Studies; Severity of Illness Index; Skin Transplantation; Treatment Outcome; Wound Healing
Keywords
Skin Transplantation
Recommended Citation
St Peter, S. D., Pera, M., Smith, A. A., Leslie, K. O., Heppell, J. Wide local excision and split-thickness skin graft for circumferential Paget's disease of the anus. American journal of surgery 187, 413-416 (2004).
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