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Page 4 of 14 Guiotto et al. Plast Aesthet Res 2023;10:26 https://dx.doi.org/10.20517/2347-9264.2023.15

evaluation by the same consultant surgeon (in terms of pain, oedema, recurrent infections, lymphorrhea/
chylorrhea), pre- and post-lymphedema stage, preoperative lymphoscintigraphy records (in some cases a
postoperative lymphoscintigraphy was performed too), transport index as well as postoperative
complications and eventual further surgeries for each patient were evaluated and collected.

The International Society of Lymphology stage (ISL) was applied to classify the disease severity degree of the
[17]
patients included in this study .

The study was conducted accordingly to the guiding principles following the Declaration of Helsinki of
1975. Informed consent was obtained from all patients, including approval for scientific publication and
photographic/video documentation.

RESULTS
This retrospective study included 16 patients (all males) with a mean age of 54 years old and an average
2
body mass index (BMI) of 29 kg/m . The follow-up was on average 40 months (ranging from 24 to 132)
[Table 1].

Regarding the aetiology of GL, primary and secondary were equally distributed: lymphatic malformation
(primary, 9 patients), related to surgery (5), multifactorial/trauma (2) (secondary) [Figure 1A].

Most of the patients with GL had an associated lower limb (LL) lymphoedema (62.5%, 10 out of 16),
distributed as follows: LL + penis + scrotum (56.3%), LL + scrotum (6.3%), penis + scrotum without LL
counted for 6 patients (37.5%) [Figure 1B].

According to the ISL, our study included 6 patients with a preoperative stage II (37.5%), 6 preoperative stage
III (37.5%), and 4 not specified.

All patients described painful oedema, while recurrent infections were associated in 87.5% of the cases;
finally, active lymphorrhea was described in 7 out of 16 patients (43.8%), always concomitant with pain,
oedema, and recurrent infections [Figure 2].

The mean time between the first symptoms displayed and surgery was 11.5 years.

Regarding the type of intervention, 50% of the patients underwent excisional surgery only, 18.8% to
microsurgery only (among these, one had a double physiologic treatment, consisting of MLVA first,
followed by a VLNT later). Finally, a combination of ablative surgery and microsurgery was performed in 5
patients (31.2%).

All patients were treated with compressive bandages, associated with physical functional therapy (penile,
scrotal and pubic lymph drainage) pre- and post-surgical procedures. Overall, anatomical lymphoedema
localisation, type, and aetiology were homogeneously distributed between the three treatment groups. No
significant difference in timing symptoms to surgery nor in lymphoedema stage between the three
treatment groups was observed.

Our study showed a significant regression of the GL ISL stage: 10 patients (62.5%) shifted from stage II/III
to a postoperative stage I, while 2 patients moved from stage III to a postoperative stage II.