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Page 12 of 14 Guiotto et al. Plast Aesthet Res 2023;10:26 https://dx.doi.org/10.20517/2347-9264.2023.15

Figure 6. Surgical treatment algorithm according to our experience.

the extra limitations. Further clinical studies with a prospective design with larger cohorts, standardised
quantification of GL and prolonged follow-up are advocated; all these will help to clarify therapeutical
protocols and improve patient outcomes.

In conclusion, for GL stage I and mild presentations, we suggest maximal conservative therapy at the first
step. In stages II and above or in the presence of persisting clinical symptoms, physiological surgery should
be proposed. Microsurgical options should be recommended in recurrent symptomatic GL (particularly
when lymphorrhea/chylorrhea and/or recurrent perineal infections dramatically impact patient quality of
life) and eventually combined with debulking.

Alternatively, in the case of chronic and extended GL stage IIb-III, excisional procedures represent our first
approach, considering the fibrotic and adipose tissue and the main component to address to reduce
anatomical deformity and functional impairments [Figure 6]. Finally, we always recommend postoperative
CDT to all patients, in order to maintain results and prevent recurrences.

DECLARATIONS
Authors’ contributions
Authors who performed the surgeries: di Summa PG, Campisi C, Maruccia M
Designed the study and participated in data analysis: di Summa PG
Performed data analysis, interpretation, and manuscript preparation: Guiotto M
Performed data acquisition, as well as provided administrative, technical, and material support: Elia R,
Molinari L, Fresa M, Nicod Lalonde M

Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author
upon reasonable request and deposited at the University of Lausanne. All figures and tables are original.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.