Surgical management of severe scrotal lymphedema

Abstract

Lymphedema is a localized retention of lymphatic fluid in the tissues, usually caused by a blockage of the vessels that carry lymph. The lymphatic system returns the interstitial fluid to the thoracic duct and this in turn, brings it to the bloodstream, where it is recirculated to the tissues. It may be an isolated phenomenon or not, as a manifestation of a congenital lymphatic dysplasia (primary) developed during the late stage of lymphangiogenesis; or it may be secondary, caused by an injury or blockage to the lymphatic vessels, either by radical surgical dissection, irradiation, malignancy, lymphangitis with lymphangiosclerosis, trauma or of an idiopathic cause. Symptoms may include severe fatigue, focal or generalized edema of some regions of the body, as well as discoloration of the skin overlying the affected area, and eventually deformity, which is called elephantiasis when it refers to the lower limbs. Lymphedema not only may cause disfiguration, but also can limit lifestyle, and even cause psychological disorders. We present the case of a 45-year old patient with severe chronic lower limb (elephantiasis), and scrotal sac lymphedema, who was evaluated and successfully treated by the Department of Plastic and Reconstructive Surgery at the Hospital Mexico.