دانلود کتاب پیشرفت‌ها در جراحی پلاستیک و ترمیمی شخصی‌سازی‌شده

While rare, penoscrotal lymphedema (PL) is typically endemic to Africa and Asia and is caused by lymphatic obstruction due to filariasis (typically Wuscheria bancrofti) or bacterial infection [1–4]. Other secondary causes include tumors, lymphadenectomy, radiotherapy, or disorders of the fluid balance, such as heart or kidney disease. Rarely, the edema can present as a symptom of a primary lymphatic malformations (i.e., Meigs and Milroy’s disease) [5–7]. Moreover, during the last two decades, an increasing number of articles have reported of cases with no clear etiology, termed idiopathic penoscrotal lymphedema (IPL) [5,8]. While benign, PL is accompanied with devastating effects on social life, sexual function, and hygiene [1,8,9]. First-line therapy for bacterial-associated PL is antibiotic treatment [10]. However, other etiologies regularly require surgery [5,8,11]. Here, primary closure, coverage with skin grafts, flap reconstruction, and microsurgical lymphaticovenous anastomoses (LVAs) in combination with surgical resection have been described [1,11–13]. Interestingly, while promising for other cases of lymphedema [8,14,15], vascularized lymph node transfer (VLNT) has not yet been assessed as a treatment for PL and was only described in two cases of PL with transplantation to the groin (17). Moreover, due to the rarity of the pathology to date, no clear consensus has been presented regarding diagnostics and, in particular, standardized treatment [4]. The purpose of this retrospective case series was therefore to evaluate the authors’ treatment approach for PL, which includes scrotal and penile resection and subsequent reconstruction alone or in combination with a free VLNT. Additionally, we set out to evaluate and present a new classification of PL and to define an algorithmic approach for the surgical treatment of PL. For this, we analyzed surgical and functional outcomes of scrotal and penile reconstructions without or with VLNT to suggest the best therapeutic option for PL.