Antoniazzi, E

Berna, G

Busato, E

Dell'Antonia, F

Grossi, U

Santoro, GA

Zanus, G

Techniques in Coloproctology

English

Grossi, Ugo

Santoro, Giulio Aniello

Antoniazzi, Elisa

Dell’Antonia, Francesco

Busato, Enrico

Berna, Giorgio

Zanus, Giacomo

Archivio istituzionale della ricerca - Università di Padova

Vol.:(0123456789) Techniques in Coloproctology (2021) 25:141–142 https://doi.org/10.1007/s10151-020-02283-wTHE LAST IMAGEBilateral lotus petal flap reconstruction for perianal Paget’s diseaseUgo Grossi1,2  · Giulio Aniello Santoro1 · Elisa Antoniazzi3 · Francesco Dell’Antonia3 · Enrico Busato4 · Giorgio Berna3 · Giacomo Zanus1Received: 11 May 2020 / Accepted: 23 June 2020 / Published online: 30 June 2020 © The Author(s) 2020A 65-year-old female patient with a history of intermittent pruritus for the past 2 years, presented with erythematous plaques with white scaling in the perineal, vulvar and peri-anal regions. Skin biopsy was consistent with Paget’s disease [1]. Given the extension of the lesions, a wide local excision and bilateral lotus petal flap reconstruction was carried out by an institutional multidisciplinary panel (Figs. 1, 2) [2, 3]. The patient recovered uneventfully. The surgical wounds healed completely without flap compromise and there was normal sphincter function at the 3-month follow-up (Fig. 3).  * Ugo Grossi  ugo.grossi@aulss2.veneto.it1 Tertiary Referral Pelvic Floor and Incontinence Centre, DISCOG, Treviso Regional Hospital, University of Padua, Treviso, Italy2 National Bowel Research Centre, Queen Mary University of London, London, UK3 Department of Plastic and Reconstructive Surgery, Treviso Regional Hospital, Treviso, Italy4 Department of Obstetrics and Gynecology, Treviso Regional Hospital, Treviso, ItalyFig. 1  Schematic representation of the lotus petal flap reconstruction142 Techniques in Coloproctology (2021) 25:141–1421 3Funding None reported.Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest.Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the insti-tutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Informed consent Informed consent was obtained from the participant included in the study.Open Access This article is licensed under a Creative Commons Attri-bution 4.0 International License, which permits use, sharing, adapta-tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/.References 1. Gaertner WB, Hagerman GF, Goldberg SM, Finne CO (2008) Perianal Paget’s disease treated with wide excision and gluteal skin flap reconstruction: report of a case and review of the litera-ture. Dis Colon Rectum 51(12):1842–1845 2. Yii NW, Niranjan NS (1996) Lotus petal flaps in vulvo-vaginal reconstruction. Br J Plast Surg 49(8):547–554 3. Hollenbeck ST, Toranto JD, Taylor BJ, Ho TQ, Zenn MR, Erd-mann D, Levin LS (2011) Perineal and lower extremity recon-struction. Plast Reconstr Surg 128(5):551e–563ePublisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Fig. 2  Flap planning was performed with handheld Doppler ultra-sound to detect perforators of the internal pudendal artery. The exci-sion included all visible lesions in the perianal skin and the posterior part of the vulva, with a 2 cm margin of healthy tissue (a). The outer 1.5 cm of the urethra were mobilized and the transverse perineal mus-cles exposed, along with the external anal sphincter (b). Two fascio-cutaneous lotus petal flaps were centred over the medial thigh crease bilaterally. They were elevated in an posterior-to-anterior direction and posteriorly rotated with a 90° angle to cover the perianal defect. A Foley urinary catheter was left in  situ for a total of 7 days (c–e). Immediate postoperative result after flap in-setting and primary clo-sure of the donor site (f)Fig. 3  The patient was continent to faeces and urine, with no signs of wound infection, break-down or haematoma at 4 (a) and 12 weeks (b) postoperatively

Bilateral lotus petal flap reconstruction for perianal Paget’s disease

Queen Mary Research Online

Vol.:(0123456789) Techniques in Coloproctology https://doi.org/10.1007/s10151-020-02283-wTHE LAST IMAGEBilateral lotus petal flap reconstruction for perianal Paget’s diseaseUgo Grossi1,2  · Giulio Aniello Santoro1 · Elisa Antoniazzi3 · Francesco Dell’Antonia3 · Enrico Busato4 · Giorgio Berna3 · Giacomo Zanus1Received: 11 May 2020 / Accepted: 23 June 2020 © The Author(s) 2020A 65-year-old female patient with a history of intermittent pruritus for the past 2 years, presented with erythematous plaques with white scaling in the perineal, vulvar and peri-anal regions. Skin biopsy was consistent with Paget’s disease [1]. Given the extension of the lesions, a wide local excision and bilateral lotus petal flap reconstruction was carried out by an institutional multidisciplinary panel (Figs. 1, 2) [2, 3]. The patient recovered uneventfully. The surgical wounds healed completely without flap compromise and there was normal sphincter function at the 3-month follow-up (Fig. 3).  * Ugo Grossi  ugo.grossi@aulss2.veneto.it1 Tertiary Referral Pelvic Floor and Incontinence Centre, DISCOG, Treviso Regional Hospital, University of Padua, Treviso, Italy2 National Bowel Research Centre, Queen Mary University of London, London, UK3 Department of Plastic and Reconstructive Surgery, Treviso Regional Hospital, Treviso, Italy4 Department of Obstetrics and Gynecology, Treviso Regional Hospital, Treviso, ItalyFig. 1  Schematic representation of the lotus petal flap reconstruction Techniques in Coloproctology1 3Funding None reported.Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest.Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the insti-tutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Informed consent Informed consent was obtained from the participant included in the study.Open Access This article is licensed under a Creative Commons Attri-bution 4.0 International License, which permits use, sharing, adapta-tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/.References 1. Gaertner WB, Hagerman GF, Goldberg SM, Finne CO (2008) Perianal Paget’s disease treated with wide excision and gluteal skin flap reconstruction: report of a case and review of the litera-ture. Dis Colon Rectum 51(12):1842–1845 2. Yii NW, Niranjan NS (1996) Lotus petal flaps in vulvo-vaginal reconstruction. Br J Plast Surg 49(8):547–554 3. Hollenbeck ST, Toranto JD, Taylor BJ, Ho TQ, Zenn MR, Erd-mann D, Levin LS (2011) Perineal and lower extremity recon-struction. Plast Reconstr Surg 128(5):551e–563ePublisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Fig. 2  Flap planning was performed with handheld Doppler ultra-sound to detect perforators of the internal pudendal artery. The exci-sion included all visible lesions in the perianal skin and the posterior part of the vulva, with a 2 cm margin of healthy tissue (a). The outer 1.5 cm of the urethra were mobilized and the transverse perineal mus-cles exposed, along with the external anal sphincter (b). Two fascio-cutaneous lotus petal flaps were centred over the medial thigh crease bilaterally. They were elevated in an posterior-to-anterior direction and posteriorly rotated with a 90° angle to cover the perianal defect. A Foley urinary catheter was left in  situ for a total of 7 days (c–e). Immediate postoperative result after flap in-setting and primary clo-sure of the donor site (f)Fig. 3  The patient was continent to faeces and urine, with no signs of wound infection, break-down or haematoma at 4 (a) and 12 weeks (b) postoperatively

Bilateral lotus petal flap reconstruction for perianal Paget's disease

WB Gaertner

NW Yii

ST Hollenbeck

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https://qmro.qmul.ac.uk/xmlui/bitstream/123456789/67136/2/Grossi_BilateralLotusPetalFlapReconst_Published-oa_2020.pdf

Bilateral lotus petal flap reconstruction for perianal Paget's disease

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