Management of Refractory Lymphedema of Perineum and Lower Limbs

Lymphedema is a chronic, progressive condition characterized by the accumulation of lymphatic fluid, followed by fat deposition and tissue fibrosis. It can also lead to local immune compromise and, in some cases, cutaneous malignancies. Here, we report a case of a patient with stage III combined perineal and lower limb lymphedema secondary to trauma. The patient was treated with lymphaticovenous anastomoses in the suprapubic region and both lower limbs, along with excision of excess skin and tissue in the perineal area. Optimal clinical improvement was achieved through this staged approach. This case emphasizes that although lymphaticovenous anastomosis effectively addresses extremity edema, radical excision remains essential for fibrotic genital elephantiasis. Comprehensive postoperative management is crucial for maintaining long-term results and minimizing recurrence.