Massive localized lymphedema of the mons: the pi-cut technique

Massive localized lymphedema (MLL) is a form of secondary lymphedema caused by obstruction of lymphatic flow seen in morbidly obese patients. Common areas for the large mass include the abdomen, suprapubic region, scrotum, and thigh. Skin changes and the sheer size cause significant morbidity. Described as a benign lymphoproliferative overgrowth, MLL if left untreated can progress to angiosarcoma. The key to resection is minimizing blood loss and the key to reconstruction is to reconstruct utilizing the principles of vulvar esthetic subunits. For hemostasis, a tourniquet is used around the base of the mass and infiltration with wetting solution is injected. Reconstruction with the “pi-cut” technique, so named because of its resemblance to the mathematical symbol of pi, allows closure along the vulvar esthetic subunits. To illustrate our surgical technique, we present a case of MLL of the mons veneris in a 53-year-old woman with a BMI (body mass index) of 78 kg/m2. The specimen weighed approximately 17.5 kg, the heaviest MLL of the mons veneris described in the literature. Our resection technique and pi-cut closure technique allowed for minimal blood loss and postoperative morbidity and an esthetic closure respecting the vulvar esthetic subunits. MLL of the mons veneris can be successfully and safely resected with an esthetic result using our technique.

Level of Evidence: Level V, therapeutic study.