Double Lotus Petal Flaps for Large Perianal Defect Reconstruction After Multistage Extramammary Paget Resection

Summary: Several reconstructive procedures have been documented for large perianal defects after extensive surgical resection. The lotus petal flap (LPF) is a fasciocutaneous flap, the use of which remains limited compared with alternative surgical techniques for the same indications. Extramammary Paget disease in the perianal area is a rare tumoral skin condition that severely affects patient autonomy. If not treated correctly, this disease can be lethal. The authors present the case of a 68-year-old male patient with a recurrence of extramammary Paget disease despite previous interventions, including multiple incomplete resections. To address the aggressive growth of perianal skin ulceration, a multistep approach including extensive en bloc resection, temporary negative pressure dressing coverage, and delayed reconstruction of the perianal area was recommended. Initially, the patient underwent a radical bilateral perianal surgical excision with wide margins. Two successive excisions were then performed to completely remove the tumor. The multistage approach was completed with wound closure using 2 bilateral LPFs, raised in the inner thigh area, measuring 11 × 16 cm on the left and 13 × 18 cm on the right. At 12-month postoperative follow-up, satisfaction was obtained in both aesthetic and functional outcomes. No impairments in ambulatory function were observed. This bilateral LPF reconstruction, associated with an extensive multistage perianal tumoral resection, offers a reliable and effective method to address extramammary Paget disease in the perianal region.