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Free omental flap for the treatment of chronic scrotal lymphedema: a case report

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Genital lymphedema, even though a benign entity, can become physically debilitating disease. Standard treatment modalities for advanced stage lymphedema, when skin changes become irreversible, are surgical debulking. Reconstruction is often done with skin grafts or local or free fasciocutaneous or myocutaenous flaps. We report a case of severe genital lymphedema that was treated with surgical debulking followed by resurfacing with a free omental flap and split thickness skin grafts. This is the first report of the use of a free omental flap for the treatment of genital lymphedema. Its large surface area, pliability, and lymphoid properties make it ideal for this form of reconstruction.

Level of evidence: Level V, therapeutic study.

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References

  1. Mcdougal WS (2003) Lymphedema of the external genitalia. J Urol 170(3):711–716

    Article  Google Scholar 

  2. Modolin M, Mitre AI, Silva JC, Cintra W, Quagliano AP, Arap S, Ferreira MC (2006) Surgical treatment of lymphedema of the penis and scrotum. Clin Sao Paolo 61(4):289–294

    Google Scholar 

  3. Scaglioni MF, Fontein DB, Arvanitakis M, Giovanoli P (2017) Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema. Microsurgery 37(8):947–953

  4. Kenworthy EO, Nelson JA, Verma R, Mbabuike J, Mehrara BJ, Dayan JH (2018) Double vascularized omentum lymphatic transplant (VOLT) for the treatment of lymphedema. J Surg Oncol 117(7):1413–1419

    Article  Google Scholar 

  5. Dandapat MC, Mohapatro SK, Patro SK (1985) Elephantiasis of the penis and scrotum. Am J Surg 149(5):686–690

    Article  CAS  Google Scholar 

  6. Wisenbaugh E, Moskowitz D, Gelman J (2018) Reconstruction of massive localized lymphedema of the scrotum: results, complications, and quality of life improvements. Urology 112:176–180

  7. Machol J, Langenstroer P, Sanger J (2014) Surgical reduction of scrotal massive localized lymphedema (MLL) in obesity. J Plast Reconstr Aesthet Surg 67(12):1719–1725

    Article  Google Scholar 

  8. Charles RH (1912) Elephantiasis scroti. In: Latham A (ed) A system of treatment, vol III. Churchill, London, pp 504–513

    Google Scholar 

  9. Balakrlshnan C (1956) Scrotal avulsion: a new technique of reconstruction by split-skin graft. Plast Reconstr Surg 18(3):232

    Article  Google Scholar 

  10. Atta A, El Basiouny SM, Abass MS (2018) Surgical treatment of scrotal lymphedema: modified surgical technique. Lymphology 51(1):38–43

    CAS  PubMed  Google Scholar 

  11. Mopuri N, O'Connor EF, Iwuagwu FC (2016) Scrotal reconstruction with modified pudendal thigh flaps. J Plast Reconstr Aesthet Surg 69:278–283

    Article  Google Scholar 

  12. Goldsmith HS, De los Santos R, Beattie EJ (1967) Relief of chronic lymphedema by omental transposition. Ann Surg 166:573–585

    Article  CAS  Google Scholar 

  13. McLean DH, Buncke HJ (1972) Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg 49(3):268–274

    Article  CAS  Google Scholar 

  14. Shimotsuma M, Shields JW, Simpson-Morgan MW, Sakuyama A, Shirasu M, Hagiwara A, Takahashi T (1993) Morpho-physiological function and role of omental milky spots as omentum-associated lymphoid tissue (OALT) in the peritoneal cavity. Lymphology 26(2):90–101

  15. Chu Y, Allen RJ, Wu T, Cheng M (2017) Greater omental lymph node flap for upper limb lymphedema with lymph nodes–depleted patient. Plast Reconstr Surg Glob Open 5(4):e1288

    Article  Google Scholar 

  16. Shash H, Al-Halabi B, Aldekhayel S, Dionisopoulos T (2017) Laparoscopic harvesting of omental flaps for breast reconstruction—a review of the literature and outcome analysis. Plast Surg 26(2):126–133

    Article  Google Scholar 

  17. Nguyen AT, Suami H, Hanasono MM, Womack VA, Wong FC, Chang EI (2016) Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema. J Surg Oncol 115(1):84–89

  18. Kamei Y, Torii S (1994) A new composite gastric seromuscular and omental pedicle flap. Ann Surg 220(1):97–101

    Article  CAS  Google Scholar 

  19. Işken T, Alagoz S, Unal C, Onyedi M, Utkan Z, Dillioglugil O (2009) A new technique for reconstruction of the avulsed scrotum: the ‘3D- prefabricated omental flap’. J Plast Reconstr Aesthet Surg 62(3):410–412

    Article  Google Scholar 

  20. Ng D, Tang CB, Kadirkamanathan SS, Tare M (2010) Scrotal reconstruction with a free greater omental flap: a case report. Microsurgery 30(5):410–413

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of Urology, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon

    Rami W. Nasr & Nassib F. Abou Heidar

  2. Department of Surgery, Division of Plastic Surgery, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon

    Reem A. Karami, Georgio M. Atallah & Amir E. Ibrahim

Authors
  1. Rami W. Nasr
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  2. Reem A. Karami
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  3. Georgio M. Atallah
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  4. Nassib F. Abou Heidar
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  5. Amir E. Ibrahim
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Corresponding author

Correspondence to Amir E. Ibrahim.

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Our Institutional Review Board does not require approval for case reports.

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Informed consent was obtained from the patient included in this study.

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The participant has consented to the submission of the case report to the journal.

Conflict of interest

Rami W. Nasr, Reem A. Karami, Georgio M. Atallah, Nassib F. Abou Heidar, and Amir E. Ibrahim declare that they have no conflict of interest.

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Nasr, R.W., Karami, R.A., Atallah, G.M. et al. Free omental flap for the treatment of chronic scrotal lymphedema: a case report. Eur J Plast Surg 44, 279–284 (2021). https://doi.org/10.1007/s00238-020-01688-y

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  • DOI: https://doi.org/10.1007/s00238-020-01688-y

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