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A Systematic Review of Outcomes After Genital Lymphedema Surgery

Microsurgical Reconstruction Versus Excisional Procedures

Guiotto, Martino MD*; Bramhall, Russell J. MBChB; Campisi, Corrado MD; Raffoul, Wassim MD*; di Summa, Pietro Giovanni MD, PhD*,†

doi: 10.1097/SAP.0000000000001875
Review Paper

Introduction Genital lymphedema (GL) surgery can be either palliative or functional. Palliative procedures involve excision of the affected tissue and reconstruction by either local flaps or skin grafts. Reconstructive procedures aim to restore lymphatic flow through microsurgical lymphaticovenous anastomoses (LVAs). This systematic analysis of outcomes and complication rates aims to compare outcomes between these surgical treatment options for GL.

Methods A systematic review of the PubMed database was performed with the following search algorithm: (lymphorrhea or lymphedema) and (genital or scrotal or vulvar) and (microsurgery or “surgical treatment”), evaluating outcomes, and complications after surgical treatment of GL.

Results Twenty studies published between 1980 and 2016 met the inclusion criteria (total, 151 patients). Three main surgical treatments for GL were identified. Surgical resection and primary closure or skin graft was the most common procedure (46.4%) with a total complication rate of 10%. Surgical resection and flap reconstruction accounted for 39.1% of the procedures with an overall complication rate of 54.2%. Lympho venous shunt (LVA) procedures (14.5%) had a total complication rate of 9%.

Conclusions This review demonstrates a lack of consensus in both the preoperative assessment and surgical management of GL. Patients receiving excisional procedures tended to be later stage lymphedema. Patients in the excision and flap reconstruction group seemed to have the highest complication rates. Microsurgical LVAs may represent an alternative approach to GL, either alone or in combination with traditional procedures.

From the *Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, UK

Department of Plastic Surgery, Lymphatic Unit, San Martino Hospital, Genova, Italy.

Received November 30, 2018, and accepted for publication, after revision January 11, 2019.

Conflicts of interest and sources of funding: none declared.

Reprints: Pietro Giovanni di Summa, MD, PhD, Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. E-mail:

Online date: May 23, 2019

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