Treatment of male genital lymphedema: An integrated concept

Torio-Padron, Nestor; Stark, G. Björn; Földi, E.; Šimunović, Filip

doi:10.1016/j.bjps.2014.10.003

Cited by 22 publications

(32 citation statements)

References 20 publications

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“…Consequently, some patients with functionally limiting disease are offered radical resection of lymphedematous tissues followed by skin grafting. [16][17][18] However, we suggest that in carefully selected patients lymphatic surgery may provide an effective alternative to radical resection.…”

Section: Discussionmentioning

confidence: 91%

Pedicled Transfer of the Superficial Inguinal Lymph Node Flap for Lymphedema

Kung

Duggan

Neligan

2017

J Reconstr Microsurg Open

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Background Vascularized lymph node transfer is performed for select patients with lymphedema who remain refractory to nonsurgical therapies. Typically, this involves a microvascular free tissue transfer of donor lymph nodes to the affected area. We describe our experience with the transfer of a pedicled adipofascial flap containing the superficial inguinal lymph nodes for lower extremity lymphedema or penoscrotal lymphedema. Methods In eight patients, a unilateral pedicled superficial inguinal lymph node flap was harvested. The flap consisted of subscarpal adipofascial tissue between the level of the inguinal ligament and the groin crease. Blood supply was from either the superficial circumflex iliac vessels or the superficial inferior epigastric vessels. In certain patients, concurrent lymphaticovenular anastomosis was attempted as well. Results Four patients underwent pedicled superficial inguinal lymph node flap transfer for lower extremity lymphedema and for the other four patients the indication was penoscrotal lymphedema. Seven of the eight study patients reported improvements in their lymphedema symptoms. Postoperative complications included cellulitis in one patient and hematoma in another patient; neither patient required reoperation. Conclusion The pedicled superficial inguinal lymph node flap is a feasible and safe treatment option for either lower extremity lymphedema or genital lymphedema. This case series provides the basis for additional studies regarding the potential use of this vascularized lymph node flap in select patients.

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Section: Discussionmentioning

confidence: 91%

Pedicled Transfer of the Superficial Inguinal Lymph Node Flap for Lymphedema

Kung

Duggan

Neligan

2017

J Reconstr Microsurg Open

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“…In cases affecting the penis-although not a conclusive concept in treatment-penis reconstructions are performed using skin grafting 7,9,10 and local flaps from surrounding healthy tissues and by advancing the foreskin to the proximal. 1,7,10,12 In scrotal reconstruction, skin flaps taken from the superior or the lateral are used following orchiopexy. In cases which this option is not possible, fasciocutaneous transposition or advancement flaps taken from medial thighs are used.…”

Section: Discussionmentioning

confidence: 99%

“…9,16 Reported early postoperative complications include hematoma and opening of the wound, and long-term complications include chronic scrotal sinus. 1,7 Given the size of the mass and the deep anemia of chronic disease secondary to frequent infections due to genital hygiene issues, surgery was the treatment proposed to our patient. While there are cases in the literature that report sedimentation and high CRP 9 , no cases are reported that describe concomitant deep anemia of chronic disease.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, micturition difficulty and sexual dysfunction are fundamental issues impacting a reduced quality of life. 1 In this study we present a very rarely seen idiopathic case of isolated massive scrotal lymphedema. This case is of significance in that it demonstrates that an isolated lymphedema can grow into massive sizes and lead to partial systemic disorders even if the patient has not undergone surgery.…”

Section: Introductionmentioning

confidence: 91%

“…Primary lymphedema can be seen to be associated with congenital lymphatic hypoplasia, as a component of a genetic syndrome such as Milroy's disease or Meigs syndrome. 1 Secondary lymphedema is usually seen following an obstruction. The most common cause of secondary lymphedema in the world is filariasis, but the number of lymphedema cases secondary to radiotherapy and lymph node dissections is also rapidly increasing.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Idiopathic Scrotal Elephantiasis

Evrenos¹,

Özkaya²,

Yaman³

et al. 2016

Turk J Plast Surg

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Treatment of secondary scrotal and lower extremity lymphedema using combined pedicled lymph node transfer and lymphaticovenous anastomosis: A case report

et al. 2020

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Combined secondary scrotal and lower extremity lymphedema is an infrequent complication of radical excision of urogenital cancers associated with pelvic lymphadenectomy. Scrotal lymphedema is usually psychologically distressing, and difficult to treat. We report a case of a 41‐years old male who presented with scrotal and left lower extremity lymphedema after radical prostatectomy and pelvic lymphadenectomy successfully treated with pedicled superficial inguinal lymph node (SILN) transfer and lymphaticovenous anastomosis (LVA) restoring the lymphatic drainage. The flap consisted of subscarpal adipofascial tissue between the level of the inguinal ligament and the groin crease measuring 11 × 7 cm. The flap composed of afferent lymphatics from the lower abdomen, lymph nodes, and fatty tissue without skin, the right‐sided flap was transposed to the root of scrotum while the left one to the proximal left thigh, then two‐level LVA were performed in the left extremity. The surgery went uneventful with no postoperative complications. At a 9 month follow‐up, there was a significant reduction of the scrotal volume with a reduction of excess volume of the lower extremity from 49.6 to 9.4% compared with the healthy side. No cellulitis was reported during the follow‐up period with improvement in the patient's clinical symptoms and quality of life. We believe that pedicled superficial inguinal lymph node flap together with LVA is a reliable and safe treatment option for either scrotal or lower extremity lymphedema following pelvic cancer treatment.

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Treatment of male genital lymphedema: An integrated concept

Cited by 22 publications

References 20 publications

Pedicled Transfer of the Superficial Inguinal Lymph Node Flap for Lymphedema

Pedicled Transfer of the Superficial Inguinal Lymph Node Flap for Lymphedema

Idiopathic Scrotal Elephantiasis

Treatment of secondary scrotal and lower extremity lymphedema using combined pedicled lymph node transfer and lymphaticovenous anastomosis: A case report

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