Successful outcome of early ambulation after extensive skin grafting in extramammary Paget's disease

• Published in: Journal of dermatology Vol. 45; no. 12; pp. 1456 - 1458
• Main Authors: Maeda, Takuya, Yoshino, Koji, Nagai, Kojiro, Oaku, Satoe, Kato, Megumi, Hata, Hiroo
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.12.2018
• Subjects: Aged; Aged, 80 and over; Delirium; early ambulation; Early Ambulation - methods; extramammary Paget's disease; Female; Graft rejection; Graft Survival; Grafts; Hemorrhage; Humans; Hypotension; Length of Stay - statistics & numerical data; Male; Malignancy; Margins of Excision; Middle Aged; Paget Disease, Extramammary - surgery; Paget's disease; Plastic surgery; postoperative complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; postoperative rest; Skin & tissue grafts; skin grafting; Skin Neoplasms - surgery; Skin Transplantation - adverse effects; Sleep disorders; Surgery; Surgical outcomes; Survival; Thrombosis; Time Factors; Treatment Outcome; postoperative complications; early ambulation; skin grafting; extramammary Paget's disease; postoperative rest
• ISSN: 0385-2407; 1346-8138
• DOI: 10.1111/1346-8138.14645

Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy that mainly affects the senior population. There is a relatively high risk of postoperative complications from surgery in the senior population, such as disuse syndrome, deep vein thrombosis and postoperative delirium. To prevent such postoperative complications, early ambulation is recommended. However, EMPD often requires extensive skin grafting because of the need for a large resection margin. To avoid skin graft failure, many institutions require that patients have several days of postoperative bedrest. For these reasons, there has been no consensus on standard postoperative rest for EMPD. In this study, we defined 20 patients who walked from the day after surgery as an “early ambulation group” and 23 patients with 5 days postoperative bedrest as a “control group”. We evaluated the skin graft survival, postoperative complications and the duration of hospitalization for both groups. Skin graft survival and complications related to the surgical wounds (infection and hemorrhage) in the early ambulation group were found to be comparable with those in the control group. Of note, the other complications (aspiration pneumonia, ileus, delirium, orthostatic hypotension and insomnia) were less frequent (P < 0.001) and the duration of postoperative hospitalization was shorter (P = 0.013) in the early ambulation group than in the control group. Our study suggests that early ambulation after surgery for EMPD does not impair skin graft survival but reduces postoperative complications and the duration of hospitalization.