Reconstruction following wide excision of perianal lesion is challenging as it requires resistance to high risks of wound contamination and preservation of anal function. Here, we present a case of a unilateral superior gluteal artery perforator (SGAP) flap with an opening in the flap. A 77-year old woman was referred due to an extramammary Pagets disease encircling the anus. Wide excision was performed by the general surgeon team, which generated a circumferential perianal defect. A unilateral SGAP flap was elevated. Primary defatting was done and an opening was made at the proper location of the anus. The anal mucosa was pulled out through the hole and sutured to the flap. She was discharged without any complications. At the follow-up visit, preservation of postoperative anal functions, as well as satisfactory contour, were observed. A well-tailored unilateral SGAP flap may be a good option for reconstruction of a perianal defect encircling the anus.
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