title: Surgical reduction of scrotal massive localized lymphedema (MLL) in obesity.
abstract: BACKGROUND
  Lymphedema of the penis and scrotum is physically and psychologically disabling. Obesity is a source of secondary lymphedema. When restricted to specific anatomical regions in obesity, this is termed massive localized lymphedema (MLL). Few surgical cases of specific scrotal MLL in obesity are reported in the literature. We present our case series to improve the management of this complicated pathology.
  
  
  METHODS
  This is a retrospective review of obese adult patients with clinically diagnosed scrotal MLL undergoing reduction scrotoplasty by the senior author (J.R.S.) from 1992 to 2012. Medical, social, familial, surgical, and follow-up data were extracted. Prior infection of the scrotal lymphedema, surgical details, pathologic evaluation, and postoperative complications were noted. A series of the cases is presented.
  
  
  RESULTS
  Four cases met the criteria for study. The average age was 35 years with an average body mass index of 53.9. Average resection at the first procedure was 3492 g. All patients were reconstructed with laterally based scrotal flaps. The pathology for each case was consistent with chronic lymphedema; no sarcomatous changes were noted. Fifty percent of the patients had recurrence of the scrotal MLL. The average total number of operations during the follow-up period for either complication or recurrence was two.
  
  
  CONCLUSIONS
  This is the largest case series specifically investigating surgical treatment for scrotal MLL in obesity. Lateral-based scrotal flaps (with or without mid-raphe Z-plasty) permit anatomic reconstruction. Complications are common and recurrence is frequent after surgical management. Excision with reconstruction improves urinary function and overall symptoms.
authors.affiliation: Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Machol
authors.affiliation: Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: P
authors.initials: P
authors.lastname: Langenstroer
authors.affiliation: Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: jsanger@mcw.edu.
authors.forename: J R
authors.initials: JR
authors.lastname: Sanger
mesh_terms: D000328:Adult; D005832:Genital Diseases, Male / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D012611:Scrotum / Q000601:surgery*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000601:surgery; D055815:Young Adult
keywords: MLL; Massive localized lymphedema; Obesity; Scrotal; Scrotoplasty