Surgical Management of Genital Lymphedema Using the Combined Charles' Procedure and Lymphatic Superficial Circumflex Iliac Artery Perforator Flap Transfer (CHASCIP).

Abstract

Despite various therapeutic options, evidence remains limited on optimal medical or surgical management of genital lymphedema in male patients. This study evaluated postoperative outcomes of male patients undergoing a combination of the Charles Procedure and lymphatic superficial circumflex iliac artery perforator (SCIP) flap reconstruction for penoscrotal lymphedema. Male patients with International Society of Lymphology stage III genital lymphedema involving the scrotum and penis were included. All underwent the Charles Procedure combined with bilateral pedicled lymphatic SCIP flap transfer. Data on demographics, indocyanine green lymphography and lymphoscintigraphy findings, symptom duration, pre- and postoperative duration of complex decongestive therapy (CDT), estimated blood loss, surgical time, length of stay, and complications were analyzed. Genital Lymphedema Score (GLS) were evaluated. Eight patients were included. The mean age was 43 years, and BMI was 28.4 kg/m². The mean follow-up was 34 months. Secondary genital lymphedema was the most common type (75%). The average weight of resected lymphedematous tissue was 1772.7 g. The mean estimated blood loss was 200.6 mL, and mean surgical time was 160 min. Two patients (25%) experienced postoperative complications: one developed seroma formation and dehiscence, while the other had partial skin graft loss. No cases of lymphedema recurrence were observed. Sexual dysfunction improved in all patients (87.5% versus 0%; p < 0.001). GLS scores significantly decreased after the procedure (6.6 versus 0.6; p < 0.001). The combined Charles Procedure and bilateral lymphatic SCIP flap transfer is an effective surgical approach for penoscrotal lymphedema, optimizing postoperative outcomes with a low complication and recurrence rate.