Frojo Gianfranco, Castro Oscar, Tadisina Kashyap Komarraju, Xu Kyle Y
Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, Mo.
Plast Reconstr Surg Glob Open. 2020 Jul 24;8(7):e2938. doi: 10.1097/GOX.0000000000002938. eCollection 2020 Jul.
Male genital lymphedema is a debilitating condition with significant physiologic and psychologic ramifications. Classical surgical treatments for male genital lymphedema include primarily ablative procedures through removal of excess soft tissue, which often have poor aesthetic and functional outcomes. Super microsurgical techniques (including lymphovenous bypass and lymph node transfers) are promising contemporary interventions. In this case report, we aim to share our experience of lymphovenous bypass with indocyanine green (ICG) lymphangiography in the management of penile and scrotal lymphedema. We performed ICG lymphography of the male genitalia and right thigh by injecting ICG at multiple sites followed by concomitant evaluation with a handheld fluorescent portable imager. Skin incisions were designed over the linear lymphatics upstream from the site of obstruction and dermal backflow. Four end-to-end and one end-to-side lymphovenous bypasses were performed. After completion, lymphovenous bypasses patency was confirmed by injecting ICG proximal to the incision and observing flow. At 10-month clinic follow-up, the patient showed marked improvement with improved skin tenting, softer tissues, improved sensation, visible dorsal penile vein, ability to retract foreskin for cleaning, and confidence to engage in sexual activities. This case report describes successful use of lymphovenous bypass in the treatment of penile and scrotal lymphedema using ICG lymphography intraoperatively to map functioning of superficial lymphatics. The full potential of this microsurgical approach is yet to be discovered, and future studies are needed to enhance the long-term outcomes for the treatment of penoscrotal lymphedema.
男性生殖器淋巴水肿是一种使人衰弱的病症，具有重大的生理和心理影响。男性生殖器淋巴水肿的传统外科治疗主要包括通过切除多余软组织的消融手术，但其美学和功能效果往往不佳。超显微外科技术（包括淋巴静脉搭桥术和淋巴结转移术）是很有前景的现代干预措施。在本病例报告中，我们旨在分享我们使用吲哚菁绿（ICG）淋巴管造影进行淋巴静脉搭桥术治疗阴茎和阴囊淋巴水肿的经验。我们通过在多个部位注射ICG对男性生殖器和右大腿进行ICG淋巴管造影，随后用手持式荧光便携式成像仪进行同步评估。在梗阻部位和皮肤反流上游的线性淋巴管上方设计皮肤切口。进行了4例端端吻合和1例端侧吻合的淋巴静脉搭桥术。完成后，通过在切口近端注射ICG并观察血流来确认淋巴静脉搭桥术的通畅情况。在10个月的门诊随访中，患者有明显改善，包括皮肤紧绷感改善、组织变软、感觉改善、阴茎背静脉可见、能够翻开包皮进行清洁以及有信心进行性活动。本病例报告描述了在术中使用ICG淋巴管造影来绘制浅表淋巴管功能图，成功地运用淋巴静脉搭桥术治疗阴茎和阴囊淋巴水肿。这种显微外科方法的全部潜力尚未被发掘，需要未来的研究来提高阴茎阴囊淋巴水肿治疗的长期效果。
