P74 Resurfacing the penoscrotum with local pedicle flaps at large defects after ablation of penoscrotal extramammary Paget's disease

Abstract

Purpose Penoscrotal extramammary Paget's disease is a rare cutaneous malignancy that primarily affects the elderly. To prevent local recurrence, adequate surgical excision with an intraoperative frozen section, proper reconstruction, and a long-term period of follow-up are required. The present study describes the treatment of patients with penoscrotal extramammary Paget's disease, with a focus on post-oncologic reconstruction. Methods Eleven patients who had undergone a local pedicle flap procedure due to the large body defects after ablation of extramammary Paget's disease of the penoscrotal area, during the period of 1999–2009. Local wide excision with intraoperative frozen sectioning was performed, and the penoscrotal wound was reconstructed with a local skin flap. Various flaps were chosen depending on the site and the defected size. If the defect size was small and scrotal tissue was adequate, only a scrotal flap (n=5) was completed for the reconstruction. Large defects with insufficient remnant scrotal tissue as well as cases in which the pubic or inguinal area was involved went through a groin flap (n=2) or an anterolateral thigh flap (n=4) among the local pedicle flaps. Results There were no complications with the postoperative wound. Furthermore, no local recurrence was noted during two to six years of follow-up (mean average 3.5 years). Conclusion For the resurfacing the penoscrotum at large defects after ablation of extramammary Paget's disease, we performed reconstruction with a local pedicle flap. In cases where the remnant tissue was sufficient, a scrotum flap was primarily used, and if additional tissue was needed a local pedicle flap; groin flap or anterolateral thigh flap, etc was applied for reconstruction. In terms of both function and cosmetic concerns, the results were satisfactory. Key Words: Penoscrotal extramammary Paget's disease, Scrotal flap, Groin flap, Anterolateral thigh flap