Supplemental Material for: Primary Perianal Paget’s Disease Treated by Bilateral Lotus Petal Flaps: A Case Report

After multidisciplinary review, fecal diversion with laparoscopic sigmoid colostomy preceded wide local excision with an intended 1-cm margin. Reconstruction used bilateral lotus petal fasciocutaneous flaps based on internal pudendal vessel perforators, elevated in the subfascial plane and rotated to resurface the defect; donor sites were closed primarily. Pathology confirmed extramammary Paget’s disease with negative margins.

Recovery was uneventful. At 6-month surveillance, the reconstruction was tension-free with no complications or clinical/imaging evidence of recurrence.</p><p><br></p><p dir="ltr">Conclusion: Primary perianal Paget’s disease may present with nonspecific symptoms, making histopathological confirmation essential. Surgical excision remains the mainstay of treatment due to high recurrence rates, while reconstruction is challenging because of anatomical and functional constraints.

In this context, the lotus petal flap provides a reliable reconstructive option, offering adequate vascularity, functional preservation, and acceptable cosmetic outcomes following wide local excision. This case illustrates that a staged, multidisciplinary approach combining oncologically sound resection with bilateral lotus petal flap reconstruction can provide durable coverage and satisfactory functional and aesthetic results, particularly for large perianal defects when diversion is warranted.

Rigorous exclusion of synchronous malignancy and long-term surveillance remain essential.</p>