Genital elephantiasis: reconstructive treatment of penoscrotal lymphoedema with a myocutaneous M. gracilis flap. Experiences from a District Hospital in Ethiopia

• Published in: Handchirurgie, Mikrochirurgie, plastische Chirurgie Vol. 40; no. 4; p. 272
• Main Authors: Prica, S, Donati, O F, Schaefer, D J, Peltzer, J
• Format: Journal Article
• Language: German
• Published: Germany 01.08.2008
• Subjects: Adult; Developing Countries; Elephantiasis - etiology; Elephantiasis - surgery; Elephantiasis, Filarial - diagnosis; Elephantiasis, Filarial - surgery; Esthetics; Ethiopia; Follow-Up Studies; Genital Diseases, Male - diagnosis; Genital Diseases, Male - surgery; Humans; Male; Microsurgery - methods; Middle Aged; Onchocerciasis - diagnosis; Onchocerciasis - surgery; Quality of Life; Surgical Flaps - blood supply; Ethiopia
• DOI: 10.1055/s-2008-1038476
• ISSN: 0722-1819

Genital elephantiasis is an illness leading to serious functional and aesthetic as well as psychosocial impairment. Since the 19th century there have been articles describing methods for surgical ablative treatment of penoscrotal lymphoedema. However, most of these methods ignore the creation a new drainage for the lymph. We now describe a new technique using a myocutaneous M. gracilis muscle flap for the reconstruction of the soft tissue damage resulting from radical excision, thus ensuring drainage of the lymph into the deep muscle compartment of the thigh. In the District Hospital "Mettu-Karl Hospital" in the Ethiopian rain forest region of Illubabor, during a period of 6 months the described surgical procedure was applied to 9 patients suffering from severe forms of this grotesquely disfiguring disease. Two patients presented with combined penoscrotal oedema, while the other 7 patients were suffering from isolated scrotal lymphoedema alone. All patients benefited from reconstruction with a myocutaneous M. gracilis muscle flap after radical excision of the affected tissue. All patients were evaluated after 3 and 12 months postoperatively in the presence of a translator. All nine patients showed a functionally and aesthetically satisfying result after 3 months without postoperative occurrence of infection. The evaluation 12 months postoperatively showed no recurrence of genitoscrotal lymphoedema. All patients reported on having regained normal ability for sexual intercourse and no occurrence of urinary tract infections since the operation. Concerning fertility, no statements could be made. A significant improvement in the quality of life was observed by the regained ability to walk and work and consequently the reintegration of the patients into their socio-economic environment. Radical excision of the affected tissue followed by transferring a functioning lymphatic drainage into the deep muscle compartment of the ipsilateral thigh using a proximally based myocutaneous gracilis muscle flap treats genital lymphoedema without recurrence. Satisfying aesthetic and functional results are achieved. The described surgical technique is still successfully being performed by two Ethiopian surgeons trained in this procedure.