Genital Lymphoedema

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Genital Lymphoedema

Postby patoco » Fri Jun 09, 2006 8:15 pm

Genital Lymphoedema

Our Home Page: Lymphedema People

http://www.lymphedemapeople.com

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Genital Lymphoedema

Male Genital Lymphoedema
Female Genital Lymphoedema
Genital Lymphoedema in Children

With anyone male or female that has lymphoedema of the lower limbs, genital lymphoedema is a very real possibility. This is especially true of those whose lymphoedema expresses itself early in childhood.

While this subject may embarrass some, there needs to be discussion and enlightenment on it.

Related terms: genital lymphoedema, lymphoedema of the scrotum, lymphoedema of the penis, scrotal edema, scrotal lymphoedema, labia swelling, vulvar lymphangioma, genital oedema, lymph scrotum, male genital lymphoedema, vulvar lymphedema, Chron's Disease, Buck's Fascia, lymphoedema of the externa genitalia, genital lymphoedema in children

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*** INTRODUCTION TO ARTICLE - FOR COMPLETE ARTICLE PLEASE CLICK ON WEBLINK AT THE END. IN THE SITE CLICK ON MEDICAL ARTICLES ***

Genital Lymphoedema

By Melanie Lewis MCSP SRP, Macmillan Lymphoedema Clinical Specialist Service Co-ordinator

Lymphoedema of the genital region is relatively uncommon, but is extremely uncomfortable and distressing for the patients who suffer with this condition. It can affect both men and women alike, but is seen more frequently in males due to the anatomical differences between the genders and effects of gravity. Around ten percent of people who develop leg oedema will have associated genital swelling, but some patients can have genital oedema alone.

In some circumstances, genital oedema can occur acutely due to trauma or cellulitis and may be able to resolve completely by itself. Far more usual however, is the chronic genital oedema, which is unfortunately irreversible, but can be controlled and reduced through appropriate lymphoedema management. The main cause of genital oedema is either due to primary or secondary lymphoedema.

Primary lymphoedema affecting only the genitals is rare. It can be noticed from birth or during the teens, and as the affected individual grows, the involved lymphatic system becomes ever more under pressure to drain the tissue fluid and the swelling becomes far more obvious. The main reasons for primary genital lymphoedema are that the lymph vessels are absent or reduced in number or simply don't work as well as they should i.e. functional failure. It has also been thought that primary lymphoedema patients who are obese, have an increased risk of genital swelling due to greater pressure on the groin from the enlarged abdomen.

Secondary lymphoedema more commonly affects the genital region than primary lymphoedema. In Africa, India and other tropical countries, genital swelling is frequently seen due to infectious diseases like filariasis. This can lead to gross elephantiasis of the penis and scrotum. In the Western world, the majority of genital oedemas are from trauma or surgery to remove gynaecological, urological, abdominal or prostatic cancers. It has been reported that up to 70% of patients treated for carcinoma to the vulva will have lower body swelling. Radiotherapy to the lymph nodes in the groin or abdominal region can also cause genital lymphoedema. The incidence also increases if there has been surgery and radiotherapy plus episodes of cellulitis.

Clinical Features

Swelling - Various parts of the genital anatomy can become swollen. In males, both the penis and scrotum, or each, can swell independently. Very few patients just have penile oedema, but it does happen, as can be seen from the case study. Sometimes, the scrotum becomes so swollen, that the patient has difficulty in walking. As the swelling increases, it can involve the area above the base of the penis (called the pubic area), thus causing the penis to retract into the scrotum. This clearly causes problems for micturition (urination)and sexual activity.

In females, the inner and outer lips of the vagina (labia) can become so swollen that they extend out of the vagina by up to 6 inches; again this creates problems for sexual activity and urination. In both genders, the pubic area on the lower abdomen alone can become oedematous, with associated skin changes and fibrosis.

Genital swelling can occur due to other causes. Palliative patients who have renal, cardiac or hypoproteinaemia (high output failure due to low protein) and patients who have had venous problems, could develop genital oedema. A clear diagnosis and medical investigations are needed, prior to lymphoedema management.

Pain is a problem for some patients, who describe a dragging, heavy, bursting sensation or an ache around the genital region. This is usually eased when the area is decongested or lifted by a jock straplike support or cycling shorts.

Skin changes are readily seen in genital oedema. Thickening and dry, flaking skin (hyperkeratosis) or warty blisters (papillamatosis) do occur as the swelling progresses.

Acute Inflammatory Episodes (cellulitis) are commonly seen in oedematous skin, which is the ideal medium for bacteria as it is generally warm, moist and has numerous crevices. The bacteria multiply in the protein rich oedema fluid, and infections can spread throughout the genital region, causing it to be red, hot, tender and swell even further. More often than not, an infection is seen as the precipitating factor in causing the swelling.

Fungal Infections do occur, due to the area being moist, warm and having so many crevices. Sweating also can trigger fungal infections.

Lymphorrhoea occurs when the tissue pressure increases and causes leakage of fluid from the thin layer of skin. Lymphorrhoea can continue for a few days or weeks and carries a high risk of developing infections. It can be very distressing for patients, as some have to wear incontinence/sanitary pads to absorb the copious fluid. Lymphoedema treatment is necessary to stop this leakage.

Sexual Dysfunction happens as the oedema increases. In males, impotence or painful erections impede sexual intercourse. Females find that the presence of oedema dampens sexual activity, due to decreased libido and pain.

http://www.lymphoedema.org/lsn/lsn140.htm#TOP

http://www.lymphoedema.org/lsn/

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When Compression Is Not Appropriate

Scrotal Oedema

Dr. Reid's Corner

I have seen several patients over the last months that highlight the risk of inappropriate use of compression. One patient had scrotal edema. He had non-Hodgkin's lymphoma and developed edema of the lower extremities and as this became worse, he developed edema of the scrotum. The edema was initially treated with diuretics, which temporarily resulted in decreased lower extremity edema but had very little effect on the edema of the scrotum. Unfortunately, the patient applied a compressive wrap. The scrotal skin is very thin and delicate and the edema further stretched the skin. The compressive garment did not help and caused area of skin breakdown leading to a severe infection. The proper treatment for this patient was to treat the cancer causing the problem, not applying compression of the swollen scrotum. The infection complicated the management of this patient since the infection had to be treated before the chemotherapy could be started. Fortunately, non-Hodgkin's lymphoma is a very treatable cancer and once the patient received the proper treatment with chemotherapy, the cancer decreased significantly in size and the scrotal edema resolved. For additional information on scrotal edema see Dr. Reid's Corner here

http://www.lymphedema.com/wcina.htm

Acknowledgment

Peninsula Medical, Dr. Reid's Corner

http://www.lymphedema.com/

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From The Yale School of Medicine

The treatment of scrotal lymphoedema.

Answer:

Worldwide, most cases of scrotal lymphoedema result from inflammation as a sequela of filarial infection, usually in tropical regions where the filariasis is endemic. In the U.S., the cause is usually surgery, irradiation, and/or cancer. The mainstay of therapy is surgical with medical therapy such as diuretics and scrotal elevation of little value except for very mild cases. Any underlying medical or infectious cause for the lymphoedema, however, should be treated prior to attempting surgical therapy.

Surgical therapy can be categorized as either bypassing (lymphangioplasty) or excisional (lymphangiectomy). While numerous lymphangioplasty procedures have been conceived using autogenous material (skin bridges, omental transposition), prosthetic conduits (nonabsorbable suture threads), and microsurgical techniques (lymphaticovenous shunts), none have found to be consistently satisfactory in long-term results. It is generally agreed that excisional therapy, which was first described by Delpech in 1820, still provides the most expeditious and reproducible results.

Numerous variations of lymphangiectomy exist but they all have in common the excision of superficial lymphatics, subcutaneous tissue, and skin at the level of Buck’s fascia on the penis with dissection of the spermatic cord and testicles from the edematous scrotal mass. Scrotal reconstruction and coverage varies. If there is not enough scrotal skin left then split-thickness skin grafts and/or fasciocutaneous thigh flaps may be necessary.

http://yalesurgery.med.yale.edu/surgery ... Ans11.html

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Congenital lymphoedema of the penis: a method of reconstruction.

Tapper D, Eraklis AJ, Colodny AH, Schwartz M.

Congenital lymphoedema of the genitalia has profound physical and psychological consequences for the growing child. Extensive resection of this tissue and reconstruction by skin grafting offers a less than satisfactory cosmetic result. Over the past year we have employed a method of total excision of the lymphedematous tissue of the penile shaft with cosmetic reconstruction without skin grafting. A circumferential incision was made 5-10 mm from the coronal sulcus and deepened to the level of Buck's fascia. The skin and subcutaneous tissue were then completely dissected away from the penis. The skin was everted and all of the abnormal lymphoedematous tissue excised up to the dermal skin margin. The skin was then tailored to the size of the penile shaft and reapproximated. This method has been employed in two patients with the advantages of (1) shorter hospitalization, (2) lack of morbidity associated with the skin donor site, and (3) satisfactory cosmetic results.

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr

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There is also an extended list of articles at this site from
PubMed (government site).

http://www.ncbi.nlm.nih.gov/entrez/quer ... id=3993854

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SCROTAL LYMPHEDEMA

Buck's Fascia Surgery

For scrotal lymphoedema, the safest and most effective surgery is called Buck's Fascia. In this surgery, the subcutaneous tissues (layer of swelling/fluid collection) of the scrotum is removed, the skin is then resected with the excess being removed.

You may find additional information under our section on genital lymphoedema. The two surgical procedures described here are the safest and most effective techniques used. However, both also may require skin grafts.

For his leg lymphoedema, he should be referred to a certified therapist to have decongestive therapy. Once the leg edema is brought under control, there are wraps and garments available that
will hold that swelling in check.

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Labial swelling, clear discharge? Suspect genital lymphedema.(After Pelvic, Gyn. Surgery)

OB/GYN News, August 1, 2003, by Kate Johnson

MONTREAL -- Unusual gynecologic complaints of labial swelling or clear labial/vaginal discharge could be symptoms of genital lymphedema, especially if the patient has had previous pelvic or gynecologic surgery or radiation affecting lymph nodes or vessels.

Awareness of this phenomenon is slowly growing among gynecologic oncologists, but until recently "there was [little recognition] that gynecologic lymphedema could complicate their treatments," Dr. Andrea Cheville, director of the University of Pennsylvania Cancer Center's Lymphedema Program, said at a meeting sponsored by the World Federation for Ultrasound in Medicine and Biology.

"I have found limited receptivity regarding lymphedema on the part of gynecologic oncologists. This reflects the general emphasis in cancer care on disease and worrying about recurrence. Historically, there hasn't been emphasis on addressing the non-life-threatening sequelae," she said in an interview.

Lymphedema can occur after treatment of gynecologic malignancies such as ovarian, endometrial, or cervical cancer, because of the extensive use of pelvic lymph node dissection and radiation therapies. In addition, treatments for bladder, colon, and renal cancer also have potential to compromise the deep lymphatic structures, increasing the risk of gynecologic lymphedema, she said.

The incidence of genital lymphedema is not known, largely because it often goes undiagnosed, but it has been estimated to occur following 10%-20% of all gynecologic oncology surgery and radiation therapy. Like other forms of lymphedema, it most commonly occurs in the first 3-4 years after cancer treatment, but can occur up to 30 years later.

"For patients with this history, if they have any genital swelling; changes in the skin texture; changes in hair growth; thickening of the labia; the presence of papillomas or discreet warty growths; or lymphorrhea, which is leakage of serous fluid through compromised or intact skin, think lymphedema," she said.

Lymphorrhea may be difficult to recognize, especially if it is occurring intravaginally, but physicians can distinguish it from normal vaginal discharge or vaginal infections in a number of ways. "Many times vaginal discharge is whitish or curdish, thick, and opaque, but this is not. Lymphorrhea tends to be clear or a little bit yellow colored. If you culture it, it will be negative. But patients may sometimes complain that it is malodorous. Lymph has no odor, but it is very proteinaceous, which makes it a good culture medium for bacteria," she said.

Genital lymphedema is a devastating condition, but unlike breast cancer, it is not a topic of polite conversation, Dr. Cheville said. She urged physicians to ask patients about these symptoms.

Treatment for the condition, as with general lymphedema, involves combined decongestive therapy consisting of compressive bandaging and manual lymph drainage, but this treatment approach can prove very problematic in gynecologic lymphedema.

"Bandaging is very difficult, because it's tricky to adequately compress the vulvar region," she noted, adding that she uses a specially designed bandage with Velcro straps and odor control pads.

She recommended that unless physicians have training in lymphedema management, they should refer the patient, but she acknowledged the difficulty in finding well-trained therapists.

"There are very few therapists who have comfort and experience treating genital lymphedema. Predominantly these would be physical therapists, but some nurses and some occupational therapists do it as well."

http://www.findarticles.com/cf_dls/m0CY ... html?term=

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The Medical Alogorithms Project - Chapter 16

16.28 Male Genital Complications of Chronic Lymphatic Obstruction (Hydrocele Lymphedema Elephantiasis Lymph Scrotum)

Overview:

Obstruction of lymphatic drainage from the male genitals can result in retention of interstitial fluid or chyle in the scrotum and/or penis. The duration and extent of the obstruction as well as development of complications determine the eventual outcome for the patient.

Causes of chronic lymphatic obstruction affecting the penis and/or scrotum:

(1) filariasis

(2) sexually transmitted infections

(3) leprosy tuberculosis or deep fungal infection

(4) malignancy

(5) idiopathic

(6) after surgery or lymph node dissection

(7) scarring and fibrosis from other causes

Manifestations:

(1) hydrocele – fluid accumulation in the scrotal sac without skin changes

(2) lymphedema - (elephantiasis when extreme) affects the scrotum and/or penis with changes in size and the skin quality

(3) lymph scrotum – vesicles filled with chylous fluid that easily break and leak

Distinction between hydrocele and lymphedema:

(1) A hydrocele may be unilateral while scrotal lymphedema is bilateral.

(2) A hydrocele does not affect the penis.

(3) In lymphedema the skin is abnormal while in hydrocele it is normal and soft.

(4) It may be hard to exclude hydrocele if lympedema is present.

Features of elephantiasis:

(1) marked deformity or enlargement of the external genitalia

(2) skin hard and thick

(3) presence of knobs or bumps

Complications:

(1) cellulitis

(2) recurrent trauma

(3) infertility

(4) psychological distress or embarassment

Preventive measures:

(1) drainage of hydrocele

(2) frequent cleansing with soap and water

(3) monitoring for breaks in the skin with prompt therapy of cellulitis

(4) proper wrapping to minimize trauma and to collect any exudate or lymph drainage

References:

Dreyer G Addiss D et al. Basic Lymphoedema Management. Treatment and Prevention of Problems Associated with Lymphatic Filariasis. Hollis Publishing Company. 2002. pages 53-62.

http://www.medal.org/xdocs/docs_ch16/do ... tml#A16.28

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Acquired vulvar lymphangioma mimicking genital warts. A case report and review of the literature.

Mu XC, Tran TA, Dupree M, Carlson JA.

Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, New York, USA.

A 44-year-old female developed confluent, dusky red, pruritic labial papules clinically suspected to be genital warts. She had a long-standing history of Crohn's disease with vulvar fistulae. The papular eruption developed after several bouts of cellulitis in a region of vulvar lymphedoema. Shave biopsy of a papule exhibited papillated epidermal hyperplasia overlying a dermis with a 'Swiss-cheese' appearance secondary to lymphoedema and superficial ectatic thin-walled vascular spaces characteristic of lymphangiectasias. Review of published cases reveals that acquired lymphangiomas often affect the vulva compared to other cutaneous sites and can be associated with surgery, radiation therapy, infection (e.g., erysipelas, tuberculosis), Crohn's disease, congenital dysplastic angiopathy and congenital lymphoedema. Rather than translucent vesicles ('frog spawn') typical of extragenital cutaneous lymphangiomas, vulvar lymphangiomas often present as verrucous papules that can be mistaken for genital warts. In this case, we believe that the combination of vulvar Crohn's disease and recurrent cellulitis resulted in local lymphatic destruction, lymphoedema and ultimately symptomatic lymphangiectasias that mimicked genital warts.

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=99249460

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Vulvar lymphoedema: unusual manifestation of metastatic Crohn's disease

Servicio de Dermatologia. Hospital Universitari Vall dHebron. Barcelona.

Cutaneous-mucosal lesions constitute one of the most frequent extraintestinal manifestations of Crohn's disease and in some cases may be the first symptom of intestinal disease. We describe the case of a 45-year-old female patient who sought medical help for genital tumefaction of 20 years' evolution. For the previous 15 years, she had been experiencing digestive symptomatology attributed to irritable bowel syndrome. Two months before the consultation, and coinciding with aggravation of the condition, the patient had been diagnosed with colonic Crohn's disease. Skin biopsy of the labia minora revealed sarcoid granulomas. The results of microbiological studies (staining for microorganisms and cultures) were negative. A diagnosis of metastatic vulvar Crohn's disease was made and, treatment with metronidazole was started, which improved the genital edema after 2 months. Genital lymphoedema is an exceptionally rare manifestation of metastatic Crohn's disease that may appear several years before intestinal symptomatology develops. Treatment with metronidazole seems to be a good therapeutic option.

Pub Med

http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract

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Male Genital Lymphoedema - Filarial infection

Tropical Medicine Central Resource

http://tmcr.usuhs.mil/tmcr/chapter26/clinical1.htm

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A new surgical approach in genital lymphoedema.

Yormuk E, Sevin K, Emiroglu M, Turker M.

Department of Plastic and Reconstructive Surgery, University of Ankara, Turkey.

A new surgical approach has been used in a case of genital lymphoedema. After resection of the lymphoedematous mass, U-shaped flaps were made from the suprapubic region anteriorly and the posterior scrotal skin posteriorly. The denuded penis was transposed to its original place by passing it through a buttonhole incision made on the anterior flap. The testicles were placed and fixed in pouches prepared between the anterior and posterior flaps. The patient had an acceptable postoperative outcome both in testicular function and habitual sexual activities.

PubMed

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr

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Lymphoedema of the external genitalia.

McDougal WS.

Department of Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.

PURPOSE: This article presents a simple classification of lymphoedema of the external genitalia, which is useful for selecting the appropriate therapy, and evaluates our experience with the various therapeutic options used to treat this disorder.

MATERIALS AND METHODS: The literature was reviewed and the records of patients treated for the disorder were analyzed.

RESULTS: A convenient classification of the disorder divides cases into congenital and acquired. Therapy is primarily dependent on whether the disease is self-limited and whether there has been any pathological change in the skin, lymphatics and subcutaneous tissue. For self-limited diseases in which no permanent pathological sequelae occur conservative therapy is appropriate. For most chronic conditions a surgical procedure is required. Excisional techniques are most effective for severe forms of the disease. In select cases subcutaneous tissue excision with preservation of the overlying skin is appropriate. However, for most patients excision of the skin and subcutaneous tissue with split-thickness grafting is most effective.

CONCLUSIONS: When patients with lymphoedema of the external genitalia require surgery and are properly selected for the appropriate procedure, the functional and cosmetic results are excellent and patient rehabilitation is likely.

Pub Med

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr

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Primary lymphoedema of the genitalia in children and adolescents.

Ross JH, Kay R, Yetman RJ, Angermeier K.

Department of Plastic Surgery, Cleveland Clinic Foundation, Ohio, USA.

PURPOSE: Congenital lymphoedema is a rare disorder that may result in disfiguring edema of the male genitalia. We reviewed our experience with 5 cases to advance our understanding of this challenging problem.

MATERIALS AND METHODS: Four boys with significant lymphoedema underwent excision of the involved subcutaneous genital tissue and coverage with local skin flaps. Two boys in whom this approach failed later underwent complete excision of the involved subcutaneous tissue and skin, and coverage with split thickness skin grafts. The boy with minimal edema was observed.

RESULTS: Two of the 4 boys who underwent subcutaneous genital tissue resection and coverage with local skin flaps are markedly improved, although 1 requires further revision. In the other 2 boys treatment failed, necessitating repeat genital tissue excision and grafting. While there have been no recurrences in the grafted areas, each patient has required additional operations to manage recurrent edema in adjacent tissues of the perineum and inguinal region, and in 1 significant contraction of the grafted skin developed. Mild genital lymphoedema in the remaining patient has remained stable during 10 years of followup.

CONCLUSIONS: Congenital lymphoedema of the genitalia is a challenging problem. Recurrences requiring multiple operations are common. We recommend expectant management of mild cases. In more severe cases excision without grafting should be attempted. While skin grafting may be the most definitive solution, it does not prevent recurrence in adjacent regions, and it carries the risk of skin contraction. Skin grafts should only be used when other techniques have failed.

MedLine

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr

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Surgical management of congenital lymphoedema in infants and children.

Fonkalsrud EW.

Of 67 children and infants with lymphoedema, 28 had the congenital type. Congenital lymphoedema appears during the first few weeks of life, frequently involves more than one extremity, and enlarges at a slower rate than general body growth. The swelling usually becomes less pronounced with age, and no specific therapy is required in two thirds of the patients. Seven of the 28 children had swelling of the upper extremities and a generalized lymphangiopathy syndrome. Subcutaneous lymphangiectomy was performed on ten of 28 patients who had moderate to severe swelling. Those with hand and arm involvement were particularly benefited; however, operations on the dorsum of the foot produced hypertrophic scars in one third of the cases. The operation is deferred until after age 2 years to permit optimal technical repair and to identify those patients whose conditions will improve spontaneously.

Pub Med

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr

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Microlymphaticovenous anastomosis for treating scrotal elephantiasis.

Huang GK, Hu RQ, Liu ZZ, Pan GP.

Scrotal elephantiasis can be physically disabling and psychologically distressing to the victim. Ablative procedure has been used in its treatment and has achieved limited success. The authors developed a microlymphaticovenous procedure to treat elephantiasis of the scrotum and applied it clinically in three patients. The immediate and long-term (13-24 months) results have been very satisfactory. The scrotum size was dramatically reduced to a nearly normal level, and subjective symptoms and objective signs were improved. The operative techniques are described, the three case histories are illustrated, and the advantages of microlymphaticovenous anastomosis, the selection of patients, and the factors required for success of the surgery are discussed.

Publication Types:

Case Reports

PMID: 3990547 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr

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Scrotal reconstruction using thigh pedicle flaps: long-term follow-up of 12 cases.

Kochakarn W, Hotrapawanond P.

Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

INTRODUCTION: Genital skin loss in men may be caused by avulsion injuries of the penis and scrotum or by gangrene of the male genitalia. Reconstruction of the scrotum after complete loss of the overlying skin is a challenging problem. We report our experience on the management of this problem. MATERIAL AND METHOD: Medical records of all male patients with massive scrotal skin loss and exposed testes treated at Ramathibodi Hospital and Noparat Rajthanee Hospital from 1990 to 1999 were reviewed. The etiologies of scrotal skin loss, technique of treatment, post-operative consequence as well as complications were noted. RESULTS: Twelve patients were described in this study. Nine patients had avulsion injuries of the penile and scrotal skin secondary to agricultural machinery accidents. Three patients were after extensive debridement of Fournierris gangrene. The exposed testes had been placed in thigh pouches and scrotal reconstruction using thigh pedicle flaps was done 4-6 weeks later. No immediate and delayed complications were detected in all of the patients. They recovered without any sequelae and had a satisfactory cosmetic result. CONCLUSION: Extensive scrotal skin loss should be immediately treated surgically. Implantation of the exposed testes in the upper thigh pouch and delayed reconstruction of the scrotum using thigh pedicle flaps can provide excellent results

PMID: 11999821 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr

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Hi everyone,

In response to dragonfly's request for some sort of video on massage, I came up with this:

I found the following videos at:

http://www.vodderschool.com/

MLD and Lymphedema/NTSC

Information video on MLD formatted for - NTSC(North America, Asia).

Featuring Hildegard Wittlinger, Director of the Dr. Vodder School - Walchsee. Austria with an introduction by Robert Harris, Director of the Dr. Vodder School - North America. Duration 19:30 mins.

This 18 minute professional video was filmed in Vancouver, B.C., Canada in 1993. It has been highly recommended by Hildegard Wittlinger of the Dr. Vodder School. The video begins with an overview of the effects of Manual Lymph Drainage (MLD®), gives a description of the lymphatic system and leads the viewer towards the treatment of lymphedema. Excerpts of the Combined Decongestive Therapy (CDT) treatment and bandaging of a lymphedema patient are shown. The video is not intended as a teaching tool or a complete picture of the Vodder method and its applications. It is, however, an excellent information and education resource for the following groups:

MLD Therapists:

This video can be used as a reminder of the basic Vodder information and lymphedema treatment, especially therapy strokes and bandaging used in MLD/CDT. It can be shown to referring doctors and colleagues to inform them more on the Vodder method of MLD and to patients to give them a better understanding of their treatment.

MLD Students:

Hildegard Wittlinger reviews the Basic course material, covering effects and indications of MLD as well as the anatomy of the lymph system. This tape will inspire students to continue with the training as it gives them an idea of the potential uses of MLD.

Patients:

Before a patient begins treatment, the therapist can use this video for the patient to show them what is involved. The patient may also wish to show it at a lymphedema patient support group, letting others know that there is a technique out there to help them.

Doctors and other health care practitioners:

This informative video reviews the lymphatic system and describes some of the implications of lymph node removal. Excerpts from the treatment of leg lymphedema following removal of the inguinal lymph nodes, demonstrate briefly to the medical doctor and health care practitioner how manual lymph drainage treatment and bandaging is performed. The intent of the video is to support the MLD therapist-doctor relationship.

Cost in US Dollars: $26.00 (includes shipping & handling)

Leg Exercise/NTSC

Leg Exercise Video formatted for - NTSC(North America, Asia).

This 15-minute video shows patients how to exercise at home or outdoors during the maintenance phase of treatment. Exercises are shown in a home environment, using familiar tools such as stairs, stools and stationary bicycles. Recommendations are shown visually, reinforcing the guidelines we give our patients.

Cost in US Dollars: $31.00 (includes shipping & handling)
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