Surgical treatment of male genital lymphedema

Use of submental and submandibular free vascularized lymph node transfer for treatment of scrotal lymphedema: Report of two cases

“…While the aim is for primary closure, often this is not possible due to the size of the defect, in which further reconstruction is necessary. These include posterior scrotal flaps (Jones & Kahn, 1970;McKay et al, 1977;Modolin et al, 2006;Thejeswi, Prabhu, Augustine, & Ram, 2012), U-shaped flaps combining anterior suprapubic and posterior scrotal flaps (Yormuk et al, 1990), lateral scrotal flaps (Garaffa et al, 2008;Kumar & Navaneethan, 2005) and split thickness skin grafts (Morey et al, 1997) The use of supermicrosurgery pioneered by Koshima in 1996(Koshima, Inagawa, Urushibara, & Moriguchi, 2000 has been well described in the literature to facilitate LVA for treatment of lymphedema, with good patient response in earlier stages of lymphedema after failure of conservative treatment. It involves the microsurgical anastomosis of lymphatic vessels to adjacent venules to bypass the region of lymphatic obstruction.…”

“…While the aim is for primary closure, often this is not possible due to the size of the defect, in which further reconstruction is necessary. These include posterior scrotal flaps (Jones & Kahn, 1970; McKay et al, 1977; Modolin et al, 2006; Thejeswi, Prabhu, Augustine, & Ram, 2012), U‐shaped flaps combining anterior suprapubic and posterior scrotal flaps (Yormuk et al, 1990), lateral scrotal flaps (Garaffa et al, 2008; Kumar & Navaneethan, 2005) and split thickness skin grafts (Morey et al, 1997), which varying levels of cosmetic results and low recurrence rates. Previous studies (Aulia & Yessica, 2020) have shown surgical techniques such as the use of excision of excess diseased tissue with and without flap reconstruction, split thickness and full thickness grafts, partial scrotectomy and more recently end to side LVA can be utilized with varying degrees of success in reducing disease burden, with subsequent increased quality of life markers reported by patients.…”

“…There are a range of surgical techniques that can be further divided into physiological and excisional procedures. Physiological treatment aims to restore patency of the diseased channels (lymphangioplasty), while excisional procedures focuses on resection of affected tissue (lymphangiectomy) (Halperin, Slavin, Olumi, & Borud, 2007; Jones & Kahn, 1970; McKay, Meehan, Jackson, & LeBlanc, 1977; Modolin, Mitre, da Silva, et al, 2006; Morey, Meng, & McAninch, 1997; Yormuk, Sevin, Emiroglu, & Turker, 1990) with either direct closure, grafts or flaps used to cover the defect. Lymphangioplasty can be further subdivided into lymphaticovenous (LVA) and vascularized lymph node transfer (VLNT) either as pedicled (Kung, Duggan, & Neligan, 2017) or free tissue transfer.…”

Secondary scrotal lymphedema: A novel microsurgical approach

“…Little information regarding treatment is available in the world literature, and medical treatment has usually proved ineffective. 1,2 A common approach involves excision of involved tissue (scrotoplasty). However, this approach does not resolve the abnormal retention of lymphatic fluid in the subcutaneous tissues secondary to lymphatics obstruction.…”

“…However, this invasive approach is still associated with the risk of lymphedema recurrence. [1][2][3] During the last decade, the development of microsurgical techniques has allowed a minimally invasive approach to the treatment of secondary lymphedema of inferior or superior extremities and more rarely of other body districts. 3 The present ''case report'' describes the application of a new microsurgical lymphovenous derivation technique for the treatment of a case of scrotal lymphedema associated to lymphedema of the lower limb secondary to radical cystectomy.…”