Long-Term Follow-Up of Single-Step Free Vascularized Lymph Node Transfer for the Management of Combined Genital and Lower Extremity Lymphedema: A Case Report

Abstract

The occurrence of genital lymphedema with lower extremity involvement is rare. There is no standard approach in the management of combined genital and lower extremity lymphedema (CGLL). The limited literature available on the management of CGLL reveals the use of multiple procedures, including vascularized lymph node transfer (VLNT), lymphovenous anastomosis (LVA), and debulking. These approaches individually target the lower extremity or genital region. There is no single-step procedure for managing the CGLL, which involves two different anatomical regions. In this case report, we describe a single-step surgical approach for managing CGLL using a single free VLNT. A fifty-four-year-old male presented with CGLL due to filariasis, affecting the quality of life (QOL) predominantly due to genital involvement. He underwent supraclavicular lymph node transfer with an elliptical skin flap of size 5 × 3 cm, placed onto the inguinal region to target the primary lymphatic drainage of both genital and lower extremities. Venous congestion during the initial postoperative period was managed by anastomosing additional veins. The patient developed donor-site lymphorrhea, which was managed conservatively. At 5 years follow-up, the patient showed clinical improvement of both genital and lower extremity lymphedema with enhanced QOL. The functional status of the VLNT was confirmed by lower extremity lymphoscintigraphy with single-photon emission computed tomography (SPECT) and scrotal lymphangiogram with indocyanine green (ICG). This case report shows the placement of a single VLNT in the inguinal region as a useful single-step approach to improve functional outcomes in the management of CGLL.