Complete Functional Lymphatic-System Pedicled Transfer (Abdelfattah)
Abdelfattah and colleagues reported excision followed by pedicled SCIP-lymphatic flap reconstruction in 26 men with advanced genital lymphedema. Mean follow-up was 44.9 months; all flaps survived, symptoms improved and all patients reported some quality-of-life benefit. This uncontrolled series supports feasibility, but does not establish superiority over other excisional or lymphatic reconstructions.[1]
For disease assessment see Genital Lymphedema and Giant Penoscrotal Lymphedema. Related options include 3R / SCIP-LIFT, CHASCIP, Debulking Scrotoplasty, LYST, VLNT and LVA.
Selection and planning
Consider this form of reconstruction when advanced scrotal or penoscrotal disease requires removal of irreversible fibrotic tissue and a suitable lymphatic-bearing flap can also provide coverage. Selection depends on the distribution of disease, donor anatomy, previous treatment, usable lymphatics, reconstructive needs and patient priorities. A particular genital size, ICG pattern or limb-based ISL stage does not establish which named operation is best.[1][2][3]
Evaluate active infection, underlying cancer or other causes of obstruction, associated leg edema, venous disease and response to conservative treatment. Previous inguinal dissection or radiation can compromise both the vascular pedicle and lymphatic donor. Assess the groin before committing to a pedicled flap.[2][3]
If nodes are to be harvested, reverse mapping is needed to identify and preserve donor-leg drainage. Surface landmarks alone do not establish a safe node-harvest zone, and mapping does not eliminate donor lymphedema risk.[3][4]
What the technique report establishes
The report describes excision of fibrotic genital tissue followed by a pedicled lymphatic SCIP flap, with partial or total scrotal reconstruction and penile skin reconstruction where needed. A pedicled flap retains its vascular connection. It still requires specialist dissection, protection of lymphatic drainage and an inset without pedicle tension or compression.[1][2]
The accessible original abstract does not verify detailed collector/node inclusion, flap number in each patient, a universal unilateral design or an identical skin paddle covering both penis and scrotum. Those details should be confirmed from the complete operative report before reproducing the named technique. "Complete functional lymphatic system" is the authors' description; it is not proof of immediate restored drainage or cure.[1]
During genital excision and reconstruction, preserve viable uninvolved tissue where appropriate, the testes and spermatic cords, urethra and penile neurovascular structures. Coverage should accommodate the actual defect and penile function. Separate penile flaps or grafts are options in related reconstructions, not evidence that one design is universally simpler or superior.[2]
Do not equate all SCIP-lymphatic operations. The author description of Yamamoto's 3R / SCIP-LIFT preserves nodes around the pedicle; node-containing LYST intentionally includes mapped nodes and afferent vessels. Their proposed mechanisms and tissue contents differ, and neither should be inferred solely from the label "SCIP flap."[2][5]
Assessing symptoms and benefit
The Genital Lymphedema Score (GLS) sums six present/absent symptoms. It is not three domains each graded 0–3.[2][6]
| Symptom | Absent | Present |
|---|---|---|
| Heaviness | 0 | 1 |
| Tension | 0 | 1 |
| Swelling | 0 | 1 |
| Urinary difficulty due to genital edema | 0 | 2 |
| Cutaneous lymphatic cysts | 0 | 2 |
| Genital lymphorrhea | 0 | 2 |
| Total | 0 | 9 maximum |
The original GLS study included 32 women with secondary lower-limb lymphedema and genital involvement and found an association with ICG genital dermal-backflow stage. Later male surgical series used it, but that does not establish comprehensive validation of every outcome or technique. A low postoperative GLS does not measure donor safety, all sexual outcomes or long-term recurrence.[6]
Reported outcomes
| Outcome | Abdelfattah 2023 report |
|---|---|
| Patients | 26 men: 15 isolated scrotal, 11 penoscrotal |
| Treatment period | February 2018–January 2022 |
| Follow-up | Mean 44.9 months; this is not the minimum follow-up for every patient |
| Scrotal coverage | Partial in 11, total in 15 |
| Penile coverage | Total skin reconstruction in 9, partial in 2 |
| Flap survival | 100% reported |
| GLS | Mean 6.2 before surgery and 0.05 afterward; reported p < 0.001 |
| Cellulitis | Reduction reported, p < 0.001; the abstract does not give absolute episode rates |
| Glasgow Benefit Inventory | Median total score +41; all 26 reported some quality-of-life improvement |
These are uncontrolled before-and-after observations after both excision and reconstruction. They do not identify how much benefit came from lymphatic transfer. Flap survival is not the absence of wound complications, donor morbidity or recurrence; a positive benefit score is not complete restoration of function.[1]
The accessible abstract does not provide detailed complication rates, postoperative compression requirements, recurrence ascertainment or a validated sexual-function endpoint. Absence of those details in the abstract must not be reported as their absence from the full paper or from patient follow-up. Numerical rankings against seven- or eight-patient series would not be a valid comparative-effectiveness analysis.[1]
Combined genital and leg lymphedema
A separate 2020 case report described a 41-year-old man after radical prostatectomy and pelvic lymphadenectomy. Bilateral pedicled superficial inguinal node-bearing adipofascial flaps were transferred to the scrotal root and proximal thigh, with distal LVA in the affected leg. At nine months, excess leg volume relative to the unaffected side decreased from 49.6% to 9.4%, scrotal swelling improved and no cellulitis was reported during follow-up.[7]
This demonstrates a possible combined strategy in one selected patient. It cannot establish a standard operation after pelvic lymphadenectomy or isolate the effect of the flap from LVA. The combined procedure includes microsurgery despite the flaps being pedicled.[7]
Follow-up
Monitor wound and flap healing, infection, donor-leg swelling or lymphatic leakage, genital symptoms, sexual and urinary function, recurrent swelling and patient-reported benefit. Record the extent and duration of compression and other conservative care. Rehabilitation should be individualized; neither the technique name nor a favorable symptom score establishes lifelong freedom from maintenance treatment.[2][3]
References
1. Abdelfattah U, Elbanoby T, Hamza F, et al. Treatment of advanced male genital lymphedema with a complete functional lymphatic system pedicled transfer. Urology. 2023;175:190–195. doi:10.1016/j.urology.2023.02.006
2. Sun JM, Yamamoto T. Genital elephantiasis: Surgical treatment and reconstruction. J Chin Med Assoc. 2024;87:142–147. doi:10.1097/JCMA.0000000000001021
3. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2023 consensus document of the International Society of Lymphology. Lymphology. 2023;56:133–151. Full consensus
4. Broyles JM, Smith JM, Wong FC, et al. Single-photon emission computed tomographic reverse lymphatic mapping for groin vascularized lymph node transplant planning. Plast Reconstr Surg. 2022;150(4):869e–879e. doi:10.1097/PRS.0000000000009557
5. Yoshimatsu H, Visconti G, Karakawa R, Hayashi A. Lymphatic system transfer for lymphedema treatment: transferring the lymph nodes with their lymphatic vessels. Plast Reconstr Surg Glob Open. 2020;8:e2721. doi:10.1097/GOX.0000000000002721
6. Yamamoto T, Yamamoto N, Furuya M, Hayashi A, Koshima I. Genital lymphedema score: genital lymphedema severity scoring system based on subjective symptoms. Ann Plast Surg. 2016;77(1):119–121. doi:10.1097/SAP.0000000000000360
7. Abdelfattah U, Elbanoby T, Ayad W, Elshamy M, Allam E. Treatment of secondary scrotal and lower extremity lymphedema using combined pedicled lymph node transfer and lymphaticovenous anastomosis: a case report. Microsurgery. 2020;40(8):901–905. doi:10.1002/micr.30656