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Case Reports
. 2022 Oct 20;2(6):33.
doi: 10.3892/mi.2022.58. eCollection 2022 Nov-Dec.

'Hanger‑shaped' scrotectomy: A novel technique for the management of penoscrotal lymphedema: A case report

Marco Capece  1 , Angelo Di Giovanni  1 , Massimiliano Creta  1 , Alessandro Giordano  1 , Carlo D'alterio  1 , Alessandro Palmieri  1 , Lorenzo Cirigliano  1 , Luigi Napolitano  1 , Claudia Mirone  2 , Gianfranco Orlandino  1 , Giuseppe Celentano  1 , Gianluigi Califano  1 , Luigi Cirillo  1 , Claudio Marino  1 , Giovanni Maria Fusco  1 , Vincenzo Mirone  1 , Roberto La Rocca  1
Affiliations
Case Reports

'Hanger‑shaped' scrotectomy: A novel technique for the management of penoscrotal lymphedema: A case report

Marco Capece et al. Med Int (Lond). .

Abstract

Massive scrotal elephantiasis is a rare disease that usually requires a surgical approach. Lymphedema of the genitalia can have a different presentation that requires different treatment. The present study describes the case of a 43-year-old Caucasian male patient by scrotal elephantiasis of unknown causes with a buried penis. A novel surgical technique was applied for the treatment of massive scrotal elephantiasis and the authors present this single-center experience. Magnetic resonance imaging revealed the integrity of the corpora cavernosa, the spermatic cords, as well as the testes. The patient underwent a scrotectomy using a 'hanger-shaped incision' followed by scrotal reconstruction to obtain an adequate cosmetic outcome. The surgical approach to this uncommon disease is referred to as a 'hanger-shaped incision'. As demonstrated herein, this novel technique permits the formation of a trapezoidal cavity that allows the reconstruction of a neo-scrotum, a neo-septum and partially restoring the natural appearance of the genitalia.

Keywords: cellulitis; genital lymphoedema; male genitalia; scrotal elephantiasis; scrotectomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Pre-operative status and patient positioning.
Figure 2
Figure 2
‘Hanger-shaped incision’.
Figure 3
Figure 3
Midline incision of the scrotum to reveal the glans.
Figure 4
Figure 4
After the midline incision of the scrotum, the glans and the inner leaflet of the foreskin were identified.
Figure 5
Figure 5
Noble structures following the mass excision.
Figure 6
Figure 6
The reconstruction of the neo-scrotum was obtained by closing the trapezoidal area of the perineum into a T-shaped line. The inferior corners of the trapezium (A and B) were lifted up and sutured to the base of the penis at the 3' and 9' o'clock positions (A1 and B1).
Figure 7
Figure 7
Reconstruction of neo-raphe.
Figure 8
Figure 8
V-Y advancement flap in the treatment of doggy ears resulted from the T-closure of the trapezoidal cavity.
Figure 9
Figure 9
Following penile degloving, the split-thickness skin graft was positioned and quilted in a spiral manner.
Figure 10
Figure 10
The post-operative appearance of the patient at 2 weeks.
Figure 11
Figure 11
The results following the surgery. Arrows indicate tension strengths distributed on three different unconnected flaps. The letters in the image indicate three different tension strengths as follows: A, right diagonal tension force; B, left diagonal tension force; C, vertical tension force.
Figure 12
Figure 12
The post-operative appearance of the patient at 6 weeks.
See this image and copyright information in PMC

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