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Surgical management of massive penoscrotal lymphedema. Case report and literature review.

INTRODUCTION
Giant lymphedema of the penis and scrotum is a rare and peculiar condition that carries many challanges for both the patient and the physician. The etiology of the disease is often difficult to trace, especially in geographical areas where filariasis is not endemic.


CASE PRESENTATION
We reported an advanced case of massive penoscrotal lymphedema presented to our plastic surgery department. Extensive physical examination and imaging investigations allowed for a wide surgical excision of the tumor with the preservation of the penile body and testicles. The reconstruction was performed with adjacent healthy skin flaps and a split-thickness skin graft for the penis. The outcome was a success and the follow-up revealed no recurrences.


DISCUSSION
Although the onset of the disease was poorly established, we regarded it as a secondary lymhpedema resulting from chronic local infection. The particularity of this case was the exclusive involvement of the superficial structures, as seen in similar cases from the literature. The clinical presentation explained by the distinctive lymphatic drainage offered a guided and rather secure surgical approach. The reconstruction techniques are varied and should not pose recurrence risks as long as functional tissue is used.


CONCLUSION
Massive penoscrotal lymphedema cases display unique evolution and features leading to great impairment. In most instances, surgery is the treatment of choice as the pathological changes are irreversible. Our technique was innovative and comprised similarities and differences compared to other research, nevertheless, the results were a success.


KEY WORDS
Penoscrotal Lymphedema, Surgical Excision, Reconstruction Techniques.