Lymphovenous anastomosis and debulking procedure for treatment of combined severe lower extremity and genital lymphedema: A case report.

Lymphedema most commonly occurs after cancer treatment and can affect limbs and genitalia. Genital lymphedema (GL) is a rare condition and can be disabling psychologically and physically. It often occurs along with lower extremity lymphedema (LEL). Conservative and physiologic reconstructive surgery such as lymphaticovenous anastomosis (LVA) offer good treatment options for LEL. GL however remains a reconstructive dilemma. The most effective surgical therapies in advanced GL are still debulking procedures in properly selected patients. Here, we present the surgical treatment of a 51 -year-old male patient with advanced and combined genital and right lower extremity lymphedema after Hodgkin lymphom treatment in the childhood. We performed multiple LVA to the right ankle joint, distal lower leg and lateral knee and 2 months later patient reported a significant decrease of pain and pressure in affected limb while the scrotal and penis lymphedema did not show any signs of improvement at all. Four months later, 4.9 kg of excessive lymphedematous tissue from the genital area was resected and covered by split-thickness skin grafts from the unaffected left upper thigh. The postoperative course was uneventful and 3 weeks postoperatively the skin graft healed completely. Follow up at 6 months showed reasonable cosmetic and functional outcomes and the patient reported a significant improvement of quality of life. We believe that debulking procedures and LVA may be combined in advanced GL and LEL and may provide good outcomes.