Surgical reconstruction of massive scrotal lymphedema associated with hidradenitis suppurativa: a case report

Abstract

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory cutaneous disease affecting apocrine glands. It can be associated with lymphedema of the surrounding tissues and most commonly affects scrotum. As a debilitating complication of HS, lymphedema can cause significant morbidity and further exacerbate HS condition, thus causing a vicious cycle. Surgery was reported to be the most common treatment for this complication. Here, we present a 41-year-old patient with massive scrotal lymphedema following a 2-year history of HS. To reduce the volume of the scrotal mass and improve the appearance and function of the scrotum, we modified the Charle's procedure by complete excision of the affected tissue while retaining the scrotal septum, preserving the subcutaneous lymphatic tissue flap, turnover of the perididymis, and primary closure. We found that this approach achieved satisfactory cosmetic results, maintained cutaneous sensation and restored erections. There was no adverse event following surgery. No recurrence occurred over 6-month of follow-up. We believe that this modified Charles' procedure can improve the morphology and lymphatic function of the scrotum and recommend its use whenever possible. While rare, HS associated lymphedema should alert clinician to the potential consequence of an advanced disease situation. Collaborative approach with surgery in the management of this condition should be considered at early stage.