The resultant build up of excess protein-rich fluid in the tissues may then lead to progressive and irreversible swelling and fibrosis.
A more unusual cause, one that we have extensive experience of managing, is when liquid silicone oil has been injected under the skin in an attempt to enlarge the external genitalia.
Whilst this dangerous ‘ cosmetic’ practice has been banned in most countries, unfortunately there are still a few unlicensed practitioners who are prepared to inject silicone oil and other inappropriate substances into patients’ genitalia.
Although silicone oil may remain asymptomatic and ‘silent’ for some years after injection, unfortunately it can eventually lead to blockage of the lymphatic channels.
This results in progressive and often massive swelling and fibrosis of the penile and scrotal tissues, greatly hindering the patient’s daily activities and quality of life.
Once genital lymphoedema has progressed to such a debilitating level, then surgical reduction of the bulky fibrosed tissues is the only effective solution.
Whilst in the very worst cases skin grafts may be necessary for reconstruction because the local genital skin has become too scarred and unhealthy to re-use, we have found that in many cases (particularly the silicone oil induced lymphoedemas) we can achieve optimal cosmetic and functional reconstruction by using local skin flaps rather than grafts.
This can greatly reduce the operative morbidity and hospitalisation time and provide for a much quicker recovery.
Thus a patient may only need to spend a couple of days in hospital, followed by another 10 days or so of recovery and healing time in a nearby hotel, after which they can usually travel safely.