Local excision combined with flap transfer for the treatment of giant perianal condyloma acuminatum: a case report.

Introduction and importance: Giant perianal condyloma acuminatum is rare in clinical practice and is mostly due to lack of timely medical intervention. Treatment options are limited, and the process is highly challenging. This study report the successful application of our combined treatment consisting of complete surgical excision and V-Y advancement flap. Case presentation: We report a patient hospitalized in our department with typical cauliflower-like masses involving the perianal region, which had progressively increased from rice-sized papules to cauliflower-like tumors surrounding the anus and reaching the perineum for almost 2 years. Human papillomavirus (HPV) genotyping (PCR-based) identified types 6 and 81. Clinical discussion: The perianal mass was completely removed. The resulting large perianal skin defect was reconstructed with V-Y advancement flap. Histopathological examination confirmed condyloma acuminatum with characteristic Koilocytes. Ultimately, the wound healed without anal stenosis, although partial flap ischemia and necrosis had occurred at postoperation. No recurrence was observed during a 4-month follow-up. Conclusion: This case highlights that high-risk individuals require early diagnosis and treatment of HPV infection. V-Y flaps are an effective and feasible technique to cover large perianal defects after aggressive surgeries. However, this technique warrants caution regarding the risk of flap necrosis.