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

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.