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. 2019:59:84-89.
doi: 10.1016/j.ijscr.2019.05.022. Epub 2019 May 14.

Surgical treatment of a penoscrotal massive localized lymphedema: Case report

Rodolfo Costa Lobato  1 , Rafael Ferreira Zatz  2 , Wilson Cintra Junior  2 , Miguel Luiz Antonio Modolin  2 , Alex Chi  2 , Yanessa Katiana Van Dunem Filipe de Almeida  2 , Rolf Gemperli  2
Affiliations

Surgical treatment of a penoscrotal massive localized lymphedema: Case report

Rodolfo Costa Lobato et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Massive localized lymphedema is an aggressive type of lymphedema that causes great functional impairment for the patient, depriving from one's basic life activities. The treatment of this type of lesion is eminently surgical, requiring ablative surgery (complete surgical resection of the lesion), but the possible techniques not always provide a good functional result.

Presentation of case: We reported a case of a penoscrotal massive lymphedema treated by our Body Contour Group/Plastic surgery department of our institute. We performed the resection of the giant penoscrotal lesion, used a posterior scrotal flap for defect's reconstruction and a split-thickness skin graft for penis' body reconstruction, closed with Z-plasty.

Discussion: Contrary to what the literature says, we prefer to use the split-thickness skin graft to reconstruct the penis' body in these cases, against local flaps. According to our experience with some similar cases, this technique provides a better functional result once it allows the penis to a better expansion during erection. The key maneuver to avoid contracture of the graft and retraction of the penis is to perform a broken line suture (Z-plasty) in the topography of the median raphe.

Conclusion: In cases of penoscrotal massive lymphedema, the treatment's option with better results is the surgical one. The use of a scrotal flap associated with split-thickness skin graft for penis provides good aesthetic and functional outcomes.

Keywords: Lymphedema; Penis; Urological surgical procedures; Urology.

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Figures

Fig. 1
Fig. 1
Preoperative - A/C: Side views; B: Frontal view; D/F: 45° views; E: Back view.
Fig. 2
Fig. 2
A-B: Preoperative surgical demarcation. C: Dissection of the penis and spermatic cord; D: Orchidopexy of the right testicle.
Fig. 3
Fig. 3
A/B: The resected lesion, frontal and side view.
Fig. 4
Fig. 4
Postoperative – A/B: Immediate postoperative – partial skin graft of the penile body with posterior Z-plasty to avoid scar contracture and reconstruction of the scrotum with the posterolateral skin flaps. C: The closure done to assure good integration of the skin graft.
Fig. 5
Fig. 5
A: 7-days postoperative; B: 20-month follow-up.
See this image and copyright information in PMC

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References

    1. Babu S., Nutman T.B. Immunopathogenesis of lymphatic filarial disease. Semin. Immunopathol. 2012;34:847–861. - PMC - PubMed
    1. Hansen K.C., D’Alessandro A., Clement C.C., Santambrogio L. Lymph formation, composition and circulation: a proteomics perspective. Int. Immunol. 2015;27(5):219–227. - PubMed
    1. Brewer M.B., Singh D.P. Massive localized lymphedema: review of an emerging problem and report of a complex case in the mons pubis. Ann. Plast. Surg. 2012;68(1):101–104. - PubMed
    1. Modolin M., Mitre A.I., da Silva J.C. Surgical treatment of lymphedema of the penis and scrotum. Clinics. 2006;61(4):2189–2194. - PubMed
    1. Shah K.G., Choksi D.B., Vohra A.S., Barad J. Giant scrotal and penile elephantiasis of idiopathic etiology. A case report. Internet J. Urol. 2007;5(1)