Surgical management of massive filarial elephantiasis of the scrotum: Highlighting reconstructive techniques using a perineal skin flap

Massive scrotal elephantiasis secondary to lymphatic filariasis is a disabling condition prevalent in endemic regions, causing severe physical, functional and psychosocial disability. Resected scrotal tissue may approach 30 kg, with a concomitant filarial hydrocoele. The penis is usually buried within the scrotal mass and then causes urinary soiling, giving a constant embarrassing smell, but may exhibit a Ram's horn deformity. The perineal skin is consistently uninvolved and may be used for total scrotal reconstruction in all cases. The inner lining of the prepuce is also spared and utilized for penile shaft coverage.