{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T01:21:04Z","timestamp":1780363264410,"version":"3.54.1"},"reference-count":35,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T00:00:00Z","timestamp":1635379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Conservative treatment represents an essential pillar of lymphedema management, along with debulking and physiologic surgeries. Despite the consistent number of treatment options, there is currently no agreement on their indications and possible combinations. When dealing with unusual lymphedema presentation as in the genitalia (Genital Lymphedema\u2014GL), treatment choice becomes even more difficult. The authors aimed to present their targeted algorithm of single and combined treatment modalities for rare GL in order to face this paucity of information. Materials and Methods: Data were collected from a prospectively maintained database since January 1983, and cases of GL that were managed in the authors\u2019 department were selected. Only patients that were treated in the authors\u2019 institution and presented a minimum follow-up of 3 months were admitted to the current study. Results: From January 1983 to July 2021, 19 patients with GL were recruited. All the patients were male, and their ages ranged from 21 to 73 years old (average: 52). Ten cases (52.6%) presented with ISL (International Society of Lymphology) stage I, five (26.3%) were stage II and four (21.1%) were stage III. GL was managed with conservative treatment (12 cases), LVA (LymphaticoVenous Anastomosis) (3) or surgical excision (4). In a mean follow-up of 7.5 years (range: 3 months\u201411 years), no major complications occurred, and all cases reached improvements in functional and quality of life terms. Conclusions: Contrary to the predominant thought of the necessity to avoid surgery in unusual lymphedema presentations such as GL, they can be managed using targeted multimodal approaches or by adapting well-known procedures in unusual ways to achieve control of disease progression and improve patients\u2019 quality of life.<\/jats:p>","DOI":"10.3390\/medicina57111175","type":"journal-article","created":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T23:51:36Z","timestamp":1635465096000},"page":"1175","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5450-0498","authenticated-orcid":false,"given":"Juste","family":"Kaciulyte","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Unit of Plastic and Reconstructive Surgery, Department of Surgery \u201cP. Valdoni\u201d, Policlinico Umberto I, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Garutti","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Spadoni","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Odontostomatological Science and Maxillo-Facial Surgery Department, Policlinico Umberto I, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Velazquez-Mujica","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9105-1839","authenticated-orcid":false,"given":"Luigi","family":"Losco","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Ciudad","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima 15082, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Marcasciano","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"UOC Chirurgia Oncologica Della Mammella, Department of Medicine, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Lo Torto","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"},{"name":"Unit of Plastic and Reconstructive Surgery, Department of Surgery \u201cP. Valdoni\u201d, Policlinico Umberto I, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato","family":"Casella","sequence":"additional","affiliation":[{"name":"UOC Chirurgia Oncologica Della Mammella, Department of Medicine, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Ribuffo","sequence":"additional","affiliation":[{"name":"Unit of Plastic and Reconstructive Surgery, Department of Surgery \u201cP. Valdoni\u201d, Policlinico Umberto I, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Chi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/SAP.0b013e318165f1f5","article-title":"Lymphedema: A Comprehensive Review","volume":"60","author":"Shimony","year":"2008","journal-title":"Ann. Plast. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/01.sap.0000257149.42922.7e","article-title":"Lymphedema: A Comprehensive Review","volume":"59","author":"Warren","year":"2007","journal-title":"Ann. Plast. 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