Restorative Challenges: Reconstruction of Large Axillary Defects Following Surgery for Extramammary Paget's Disease

Extramammary Paget's disease (EMPD) is a rare malignant neoplasm arising from apocrine gland-bearing skin, with involvement of the axilla being particularly uncommon. Surgical excision remains the first-line treatment. However, management can be challenging because wide excision to achieve tumor-free margins may result in a large axillary defect in a high mobility region where scar contracture can compromise shoulder function. Here, we report a single case of axillary EMPD managed with surgical excision and reconstruction using a pedicled thoracodorsal artery perforator (TDAP) flap. This case highlights the pedicled TDAP flap as a reliable, muscle-sparing reconstructive option for managing large axillary defects after EMPD excision, offering favorable functional and aesthetic outcomes with minimal donor-site morbidity.