Surgical treatment of a penoscrotal massive localized lymphedema: Case report

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.