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Background: Following advanced malignancy in the pelvis, reconstruction of the defect arising from the primary surgical procedure is often required. This study compares patient demography and 30-days postoperative donor and recipient site complications in patients treated with a pedicled transpelvic Vertical Rectus Abdominis Myocutaneous (ptVRAM) flap. Methods: Sixty-seven patients treated with a ptVRAM flap in 2015 and 2016 were included in the study. Patient demography, surgical indication, treatment, and surgical data were compared between patients with and without complications. Fisher’s exact test and the Mann-Whitney U test were used to compute p-values. Results: This study shows a total donor and recipient site complication rate of 42% (n = 28) and the total 3-year survival was 73% (n = 49). Patients with a BMI ≥ 32 kg m-2 showed a significant correlation (p = 0.03) with postoperative complications. Smokers, patients with total vaginal reconstruction, and patients with one or more comorbidities were found to have a non-significant correlation with total postoperative complications (p = 0.13, p = 0.16, p = 0.17). Conclusions: PtVRAM flaps can be used in the reconstruction of pelvic defects following advanced malignancies in patients previously treated with neoadjuvant chemo- or radiotherapy. Our results fall well within the findings of other studies and add to our knowledge of the surgical implications of treating perineal defects. Level of Evidence: Level IV, risk / prognostic study.

Extramammary Paget’s disease (EMPD) is a rarely described skin neoplasm primarily affecting the anogenital region. The diagnosis of EMPD is often delayed due to misdiagnosis which results in delayed treatment. Surgical excision is the mainstay of treatment in patients diagnosed with EMPD. However, cancerous remains are relatively often found due to difficulties with defining the tumor margins during surgery. This results in multiple re-excisions and potential dissemination. We here present two cases of primary EMPD in males and challenges associated with EMPD treatment. Mapping biopsies can provide valuable knowledge and prohibit multiple unsuccessful re-excisions, in patients where the tumor border is difficult to define. A mapping strategy can also contribute to a reduced skin excision, which is crucial in the genital region. Furthermore, we find that PET-CT is an important tool in the disease staging and, hence, selection of adequate treatment strategies. Level of evidence: Level V, therapeutic study.