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Case Reports
. 2016 Jan 21:5:Doc07.
doi: 10.3205/iprs000086. eCollection 2016.

Management of a giant perineal condylomata acuminata

Evelyn Hemper  1 , Mathias Wittau  1 , Johannes Lemke  1 , Marko Kornmann  1 , Doris Henne-Bruns  1
Affiliations
Case Reports

Management of a giant perineal condylomata acuminata

Evelyn Hemper et al. GMS Interdiscip Plast Reconstr Surg DGPW. .

Abstract
in English, German

A condylomata acuminata infection is caused by human papillomaviridae (HPV). This sexually transmitted condition most often affects the perineal region. Importantly, infections with types 16 and 18 are associated with an increased risk for anal and cervix cancer. In most cases topical therapy is sufficient for successfully treating condylomata acuminata. Here, we report the case of a 51-year old patient who suffered from a giant perianal located condylomata acuminata which had developed over a period of more than 10 years. Imaging by MRI revealed a possible infiltration of the musculus sphincter ani externus. Because a topical treatment or a radiotherapy was considered unfeasible, a surgical treatment was the only therapeutic option in this unusual case. First, a colostomy was performed and subsequently a resection of the tumor in toto with circular resection of the external portion of the musculus sphincter ani externus was performed. The large skin defect was closed by two gluteus flaps. The rectum wall was reinserted in the remnant of the musculus sphincter ani externus. Postoperatively, parts of the flaps developed necrosis. Therefore, a vacuum sealing therapy was initiated. Subsequently, the remaining skin defects were closed by autologous skin transplantation. Six months later the colostomy could be reversed. To date, one year after first surgery, the patient has still a normal sphincter function and no recurrence of the condylomata acuminata. This case report demonstrates how giant condylomata acuminata can be successfully treated by extended surgical procedures including colostomy and plastic reconstruction of resulting defects upon resection.

Condylomata acuminata werden durch humane Papillomaviren verursacht. Der Übertragungsweg erfolgt durch Schmier-und Kontaktinfektionen. Zervixkarzinome und Analkarzinome sind in 70% assoziiert mit den Subtypen der humanen Papillomaviren 16 und 18. In den meisten Fällen ist eine topische Therapie des Condylomenrasens ausreichend.Wir berichten über einen 51-jährigen Patienten, der sich mit einem seit 10 Jahren bestehenden und progredienten perineal gelegenen Condylomenrasen vorstellte. Die Condylomata acuminata-Besiedlung war durch den Subtyp 6 des humanen Papillomavirus verursacht. Die Größe des Condylomata acuminata-Rasens betrug 16 cm in der Längsausdehnung. Im MRT des Beckens konnte eine Infiltration des Musculus ani externus nicht sicher ausgeschlossen werden. Eine topische Therapie oder eine Bestrahlung war aufgrund der Größe nicht möglich. Es erfolgte zunächst die Anlage eines doppelläufigen Descendostomas und anschließend eine Resektion des Tumors in toto unter Mitnahme des äußeren Anteils des Musculus ani externus. Der sehr große Hautdefekt, der beide Glutei betraf, wurde mittels zwei subkutaner Gluteusschwenklappen gedeckt. Die Mucosa des freiliegenden Musculus ani extrenus wurde zirkulär an die Haut der Gluteusschwenklappen adaptiert. Postoperativ traten am Oberrand beider Schwenklappen eine livide Verfärbung in der Breite von ca. 4 cm auf, die reseziert wurden. Diese Fläche wurde mittels einer Vakuumversiegelungstherapie behandelt. Nach 7 Wochen konnte der Defekt mittels eines Spalthaut-Meshgrafts gedeckt werden. 6 Monate später konnte das Descendostoma zurückverlagert werden. Der Patient ist kontinent und es besteht eine normale Sphinkterfunktion. Dieser Fallbericht zeigt, dass ein perinealer Condylomenrasen in dieser Größe nur durch eine chirurgische Exzision mit vorheriger Anlage eines protektiven Stomas und einer plastischen Rekonstruktion erfolgreich behandelt werden kann.

Keywords: condylomata acuminata; human papillomaviridae.

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Figures

Figure 1
Figure 1. A) Preoperative aspect of the lesion (16 x 12 cm). B) Preoperative MRI: Suspect infiltration.
Figure 2
Figure 2. A) Situation prior the en bloc resection of the condylomata acuminate. The mucosa of the musculus sphincter ani externus is armed by sutures. B) Specimen after resection.
Figure 3
Figure 3. After resection, the mucosa of the musculus ani externus was fixed by circular sutures into the edge of the skin.
Figure 4
Figure 4. The large skin defect was closed by two gluteus flap.
Figure 5
Figure 5. Postoperative result 6 months after the resection. The patient had a normal sphincter function. Aspect of the perianal region in prone position.
See this image and copyright information in PMC

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