Modified radical inguinal lymphadenectomy for carcinoma of the penis: technique and results

PURPOSE: Modified radical inguinal lymphadenectomy for carcinoma of the penis is presented that satisfies the requirement for complete groin dissection, while significantly decreasing postoperative complications. MATERIALS AND METHODS: Eight patients with squamous cell carcinoma and 2 with leiomyosarcoma of the penis underwent bilateral modified inguinal lymphadenectomy, including removal of the superficial and deep inguinal lymph nodes. To avoid damage to the vessels of the groin region that run parallel to the inguinal ligament and lie in the fat of the superficial layer of the superficial fascia dissection is done beneath this layer. The proper cleavage plane is just above the membranous layer of the superficial fascia, beneath which the superficial inguinal lymph nodes are located. The saphenous vein is preserved and the sartorius muscle is left in situ, so as not to disturb collateral lymphatic drainage. RESULTS: At a followup of 6 to 104 months no skin necrosis, infection or deep venous thrombosis occurred. In 2 patients early moderate lymphedema of the lower extremities resolved with time, 2 had scrotal edema and 3 had a transient lymphocele. CONCLUSIONS: As described, modified radical inguinal lymphadenectomy decreases the morbidity associated with groin dissection, while removing superficial and deep inguinal lymph nodes.     

Ileocecal vascularized lymph node transfer for the treatment of extremity lymphedema: A case report

Vascularized lymph node (VLN) transfer has been of high interest in the past decade for the treatment of lymphedema, since it has been shown to be effective in reducing limb volumes, decreasing infectious episodes and improving quality of life. Multiple donor sites have been described in the quest for the optimal one. Herein, we describe a novel lymph node flap option based on the ileocolic artery and vein. The ileocecal vascularized lymph node (IC‐VLN) flap was used in the management of a 33‐year‐old male patient with lower extremity lymphedema secondary to left inguinal trauma. The patient had previously underwent a pedicled omentum flap transposition with minimal improvement in limb size and persistent episodes of infection. At 15 month follow‐up, the IC‐VLN flap improved the lymphatic drainage in the affected limb with a mean limb circumference reduction rate of 26.3%. No donor site complications or further episodes of infection were noted. According to our findings, the IC‐VLN flap may be another option for VLN transfer in very selected cases. Nevertheless, larger series with a longer follow‐up are required to analyze the efficacy and long‐term results of this flap.     

The significance of inguinal lymphadenectomy in carcinoma of the penis

The occurrence of inguinal lymph node metastases from squamous cell carcinoma of the penis depends on local tumor extension, tumor grade, and vascular invasion. Whilst imaging techniques and fine needle biopsy can detect metastases to the inguinal nodes, resection of the superficial inguinal nodes remains the procedure of choice for diagnosis. The risk profile defined in the guidelines of the EAU is used to decide whether modified inguinal lymphadenectomy is indicated in the case of nonpalpable lymph nodes. Resection of the sentinel lymph node marked by (99)Tc and dye has not yet been adequately evaluated as an alternative to be accepted as the standard method.When the superficial inguinal lymph nodes are found to harbor metastases the next step is a radical bilateral inguinal lymphadenectomy. When metastases are found in two lymph nodes or extranodal tumor growth is observed, or imaging techniques reveal enlarged nodes in the pelvis the lymphadenectomy is extended to the pelvic nodes. With appropriate surgical technique and postoperative care the complication rate is low; in particular, persistent lymphedema of the legs is rarely observed. Chemotherapy and radiotherapy and the two combined have not been tested for efficacy, but are used individually before and after surgery, depending on the local tumor extent.     

Modified lymph vessel flap transplantation for the treatment of refractory lymphedema: A case report

Lymph vessel flap transplantation (LFT), lymphaticovenous anastomosis (LVA), or lymph node flap transfer are sometimes used to treat lymphedema that is resistant to conservative treatment. LFT harvested from the contralateral limb has been reported for the treatment of lymphedema. Here we report the use of modified LFT from the abdominal wall for the treatment of refractory lymphedema. Our patient was a 57‐year‐old patient with secondary lower limb lymphedema was previously treated with conservative therapy and lymphaticovenous anastomosis. We first examined the lymphatic function of the lower abdominal region in the patient using indocyanine green (ICG) lymphography. After confirming the good lymphatic function in the right abdominal region, we harvested the pedicled abdominal adiposal flap containing multiple abdominal lymph vessels and transferred it to the left groin region. The flap (20 × 10 cm²) was based on the superficial circumflex iliac artery perforator. We anastomosed one lymph vessel in the flap to that in the recipient site. We also performed multiple fibrotripsy using a 3‐mm‐diameter stainless steel stick inserted into small incisions. The postoperative course was uneventful. The circumference measurement was decreased by 2.2–13.5 cm at 1 year after the operation. The lower abdominal region has many lymph vessel networks and is thought to be a less risky donor site in patients with lymphedema than the lower limbs. Thus, LFT may be an option for the treatment of chronic lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:695–699, 2016.     

阴茎癌根治性髂腹股沟淋巴结清扫术的改进

目的:对根治性髂腹股沟淋巴结清扫手术进行改进,以完整清除淋巴结并减少术后并发症。方法:2003~2004年对20例阴茎鳞状细胞癌患者施行根治性腹股沟淋巴结清扫,其中5例还施行了髂淋巴结清扫。腹股沟区的清扫范围包括腹股沟浅组和深组淋巴结,采用暴露好的直切口,皮瓣厚度适中,切断大隐静脉且不转移缝匠肌。髂淋巴结清扫采用下腹正中切口,术后采用逐步降低的负压吸引促进引流和皮瓣愈合。结果:两侧腹股沟区淋巴结平均为21个,阳性淋巴结平均为1.6个。术后病理检查证实55%的患者有淋巴结转移,纠正了40%的术前分期。术后有1例出现高热和局部感染,另有27.5%的单侧腹股沟区域出现局部并发症,包括皮缘坏死、愈合延迟、皮下积液和淋巴瘘。无一例出现大面积皮片坏死和股血管损伤。结论:改进的根治性髂腹股沟淋巴结清扫手术保证了清扫范围,减少了手术并发症。     

减少阴茎癌腹股沟淋巴结清扫术并发症的临床技巧研究(附30例报告)

目的探讨减少阴茎癌腹股沟淋巴结清扫术后并发症的手术操作技巧及其效果。方法回顾性分析2000年1月至2011年10月间收治的30例行改进根治性双侧腹股沟淋巴结清扫术的阴茎癌患者的临床资料。30例共60侧行腹股沟淋巴结清扫,其中29例为阴茎癌手术时同期淋巴清扫。清扫范围足够,淋巴结清除彻底,改进技术包括设计腹股沟"S"形皮肤切口、通过确认Campas筋膜的膜性解剖标志层来分离皮瓣、皮瓣边缘缝线牵引、完整保留阔筋膜、尽可能保留阴部外浅静脉、术后良好的引流及加压包扎。结果 30例患者随访5～128个月,共发生并发症15侧次(25.0%),其中轻度皮瓣坏死4侧次(6.7%)、切口感染3侧次(5.0%)、淋巴水肿8侧次(13.3%),无下肢深静脉血栓。结论通过改进腹股沟淋巴结清扫术可有效减少阴茎癌患者腹股沟淋巴结清扫术后并发症。     

Chimeric thoracodorsal lymph node flap with a perforator-based fasciocutaneous skin island for treatment of lower extremity lymphedema: A case report

Free vascularized lymph node transfer (VLNT) is applied more and more in the treatment of lymphedema. A random-pattern skin island with VLNT is of use but can have its limitations in flap inset. We describe an option for free VLNT in the treatment of lower extremity lymphedema. We present the case of a chimeric thoracodorsal lymph node flap (TAP-VLNT) with a thoracodorsal artery perforator (TAP) flap (5 × 9 cm) to the lower leg in a 22-year old female patient with stage 2 lower leg lymphedema caused by severe traumatic skin decollement and postoperative scarring after a car accident. TAP flap enabled tailored and tension-free wound closure at the recipient site after scar release and lymph node flap inset. The anastomosis was performed to the anterior tibial artery. The postoperative course was uneventful with no complications or secondary donor-site lymphedema. Follow-up at 6 months showed reasonable cosmetic and functional outcomes. The circumference reduction rate was up to 11% and the patient reported improved quality of life. The purpose of this report is to describe a case of a more flexible lymph node flap inset and tension-free wound closure by harvesting a thin thoracodorsal artery perforator (TAP) skin island together with a thoracodorsal VLNT as a chimeric flap (TAP-VLNT) for treatment of lower extremity lymphedema. Larger series with longer follow-up data are needed to justify its widespread use and demonstrate long-term results.     

Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series

PURPOSE: We examined complications in a contemporary population of patients with penile cancer undergoing inguinal lymphadenectomy with or without pelvic lymphadenectomy. MATERIALS AND METHODS: The records of all patients treated for squamous cell carcinoma of the penis from January 1992 to May 2003 were reviewed. Complications and length of stay were examined. Complications were divided into early (30 days or less after surgery) and late (greater than 30 days). RESULTS: A total of 41 men were diagnosed with squamous cell carcinoma of the penis, of whom 22 underwent a total of 40 inguinal lymphadenectomies (ILs). Of the patients 13 underwent unilateral IL, 9 underwent simultaneous bilateral ILs and 10 underwent pelvic lymphadenectomy. Mean followup was 34.2 months (range 9.2 to 69.3). Early complications were lymphedema in 4 of 40 cases (10%), minor wound infection in 3 (7.5%) and minor wound separation in 3 (7.5%). Additionally, 5 of 40 patients (12.5%) had lymphoceles, which spontaneously resolved. Late complications were lymphedema in 2 of 40 patients (5%), flap necrosis in 1 (2.5%) and lymphocele in 1 (2.5%), requiring percutaneous drainage. There was no significant difference in the complication rates in patients with unilateral dissection compared to bilateral or pelvic lymph node dissection. Median length of stay was 2 days (range 1 to 9). There was no significant difference in hospital stay for unilateral dissection compared to bilateral or pelvic lymph node dissection. CONCLUSIONS: These data demonstrate the relative safety of a contemporary lymphadenectomy. We believe that these results lend support to early lymphadenectomy, including simultaneous bilateral dissections, when clinically indicated. Furthermore, these results demonstrate the benefits of a standard postoperative pathway using compression stockings, sequential compression devices and early ambulation with restricted anticoagulant use.     

阴茎癌切除同期行改良根治性腹股沟淋巴结清扫术的可行性研究

目的 探讨同期行阴茎癌原发病灶切除和改良根治性腹股沟淋巴结清扫术的可行性.方法 回顾性分析2002年6月至2010年6月55例同期行阴茎癌切除和改良根治性腹股沟淋巴结清扫术的患者资料.患者年龄27～73岁,平均49岁.行同期改良根治性腹股沟淋巴结清扫术107侧,1侧行腹股沟淋巴结清扫术之前曾行大隐静脉抽出术,2侧行同期经典根治性腹股沟淋巴结清扫术. 结果 107侧改良根治性腹股沟淋巴结清扫术后发生切口感染1侧次(0.9％),下肢淋巴水肿18侧次(16.8％),皮瓣坏死6侧次(5.6％).每侧切除淋巴结3 ～23枚,平均11枚.3年总生存率为84％. 结论 阴茎癌切除同期行改良根治性腹股沟淋巴结清扫术可保证控瘤效果,不增加手术后并发症,是适合阴茎癌患者的治疗策略.     

薄层血管化腹股沟淋巴结皮瓣移植联合反向淋巴显影在继发性上肢淋巴水肿手术中的应用

目的 探讨薄层血管化腹股沟淋巴结皮瓣移植联合反向淋巴显影在继发性上肢淋巴水肿手术中的应用效果。方法 2019年7月至2020年9月,应用吲哚菁绿、美蓝双染法引导的反向淋巴显影术,制备薄层游离血管化腹股沟淋巴结皮瓣,切取后移植于患侧上肢,治疗乳腺癌术后继发性淋巴水肿患者5例。皮瓣约10 cm×5 cm大小,平均厚度约0.7 cm,切取供区淋巴结约2～3枚,术后随访7～15个月。结果 5例皮瓣存活良好,淋巴结均存活。术后随访显示,患肢臂围均于1.5个月后出现明显缩小,供区无并发症。结论 联合反向淋巴显影技术完成的薄层血管化淋巴结游离皮瓣移植治疗继发性上肢淋巴水肿疗效优良,明显改善患肢臃肿外形。     

Secondary scrotal lymphedema: a novel microsurgical approach

Secondary scrotal lymphedema is an infrequent complication of radical cystectomy assiociated with pelvic lymphadenectomy. We report a case of secondary lymphedema of male genitalia presenting more than 4 years after a radical cystectomy with extended pelvic lymphadenectomy for adenocarcinoma of the bladder. Microsurgical lymphovenous anastomoses are usually performed using only the scrotal lymphatics excluding the testicular lymphatics drainage. We have experimented a new microsurgical technique based on lymphovenous anastomosis between the collectors of the spermatic funiculus and the veins of the pampiniform plexus, allowing the testicular lymphatic drainage.     

Lymphadenectomy of the inguinal region and pelvis]

The draining lymph nodes of extra-abdominal tumors and malignant lesions of the lower extremity are located in the groin and iliac region. Malignancies with lymphatic drainage into this region include tumors of the anorectum, penis and vulva, skin (melanoma, squamous cell carcinoma), and soft tissue sarcomas. Current clinical research in biology, routes of lymphatic spread, and the possibility of marking the sentinel lymph node has directed lymphadenectomy strategy toward differential procedures, depending on the type of underlying malignancy. The spectrum of lymphadenectomy includes diagnostic lymph node removal of clinically enlarged nodes, removal of the sentinel node, and radical lymphadenectomy. Lymphadenectomy can also be indicated as a palliative procedure. The indications also depend on the type of tumor, previous treatment, and disease prognosis. This review presents the current state of indications and surgical techniques of inguinal and iliacal lymphadenectomy.     

Modified lambda‐shaped lymphaticovenular anastomosis with supermicrosurgical lymphoplasty technique for a cancer‐related lymphedema patient

Supermicrosurgical lymphaticovenular anastomosis (LVA) has become a useful option for the treatment of compression‐refractory lymphedema with its effectiveness and less invasiveness. It is important to make as many bypasses as possible for better treatment results of LVA operation. We report a secondary lymphedema case successfully treated using a modified lambda‐shaped LVA. A 62‐year‐old female with secondary lower extremity lymphedema (LEL) refractory to conservative treatments underwent LVA operation. A modified lambda‐shaped LVA was performed at the left groin. In modified lambda‐shaped LVA, two lymphatic vessels were transected, and both ends of the proximal and distal sides were converged respectively for an end‐to‐side and end‐to‐end anastomoses to one vein. Using modified lambda‐shaped LVA, four lymph flows of two lymphatic vessels could be bypassed into a vein. Six months after the LVA surgery, her left LEL index decreased from 261 to 247, indicating edematous volume reduction. Modified lambda‐shaped LVA effectively bypasses all lymph flows from two lymphatic vessels, when only one large vein can be found in the surgical field. © 2013 Wiley Periodicals, Inc. Microsurgery 34:308–310, 2014.     

Immediate inguinal lymphaticovenous anastomosis following lymphadenectomy in skin cancer of lower extremities

BackgroundSecondary lymphedema following inguinal lymph node dissection in lower extremities skin cancer reduce the patients’ quality of life. Immediate lymphaticovenous anastomosis (LVA) at groin is a procedure intended to prevent secondary lymphedema. The data regarding the long-term efficacy and safety of this procedure was limited. Therefore, we evaluated the long-term outcomes of immediate LVA in patients with melanoma and non-melanoma skin cancer of the lower extremities.MethodsThe retrospective data review of patients with melanoma or squamous cell carcinoma of the lower extremities underwent oncologic tumor resection with groin node dissection between December 2013 and December 2016 was performed. Seven patients underwent immediate LVA (intervention) at groin after node dissection and 22 acted as controls. The occurrence of lymphedema and oncologic outcomes were followed up to 7 years.ResultsFifteen patients (51.7%) developed postoperative lymphedema, which were three patients in the intervention group and twelve patients in the control group (p = 0.68). The intervention group had significant lower 2-year (57.1% versus 77.3%) and 5-year overall survival (14.3% versus 54.5%) (p = 0.035). The intervention group had reduced 2-year (28.6% versus 86.4%) and 5-year (28.6% versus 68.2%) Recurrence Free Survival (RFS) (p = 0.013). The intervention group also had reduced 2-year (0% versus 90%) and 5-year (0% versus 70%) Metastasis Free Survival (MFS) (p = 0.003).ConclusionImmediate inguinal LVA following groin node dissection in lower extremity skin cancer patients did not reduce the incidence of lymphedema. Unfortunately, it was associated with lower overall survival and an increase in tumor recurrence and metastasis.     

Preventing Lymphedema and Morbidity With an Omentum Flap After Ilioinguinal Lymph Node Dissection

Background Pedicled omentoplasty has been advocated to prevent the formation of lymphocysts and lymphedema after pelvic lymph node dissection, We evaluated the possible benefit of a pediculated omentoplasty placed in the groin for preventing complications after ilioinguinal lymph node dissection. Methods In this pilot study, we report a series of four women and three men with inguinal metastatic lymph nodes. Each was treated with a pediculated omentoplasty after groin dissection. We examined complications such as lymphedema, lymphorrhea, wound breakdown, skin necrosis, and lymphocysts. Results Only one wound breakdown with skin necrosis was observed, and it healed satisfactorily in 10 days without exposing the femoral vessels. No lymphocele or infectious complications occurred, even though no antibiotic prophylaxis was used. Midthigh circumference increase ranged from 1.5 to 7 cm in four cases but remained asymptomatic. Furthemaore, lymphedema of the lower limb decreased in the three remaining patients, who previously had an enlargement of the thigh. No evidence of peritoneal carcinomatosis was noted during the 4-month follow-up. Conclusions Pedicled omentoplasty seemed to facilitate the absorption or transport of lymph fluids and resulted in less lymphedema in the lower limb even after radiotherapy. Pedicled omentoplasty reduces both short-term and long-term postoperative complications without affecting treatment outcome and could even be considered as a safe and effective therapy for lymphedema of the lower extremity.     

Ladder‐shaped lymphaticovenular anastomosis using multiple side‐to‐side lymphatic anastomoses for a leg lymphedema patient

Lymphatic supermicrosurgery, supermicrosurgical lymphaticovenular anastomosis (LVA), is becoming a useful option for the treatment of compression‐refractory lymphedema. One of the most important points in LVA is to make as many bypasses as possible for better treatment results. We report a progressive lower extremity lymphedema (LEL) case successfully treated with a ladder‐shaped LVA. A 67‐year‐old female with secondary LEL refractory to conservative treatments underwent LVA. A ladder‐shaped LVA was performed at the left ankle. In the ladder‐shaped LVA, 3 lymphatic vessels and 1 vein were anastomosed in a side‐to‐side fashion; 2 lymphatic vessels next to the vein were anastomosed to the vein, and the other lymphatic vessel was anastomosed to the nearby lymphatic vessel. Using ladder‐shaped LVA, 6 lymph flows of 3 lymphatic vessels could be bypassed into a vein. Six months after the LVA operation, her left LEL index decreased from 212 to 195, indicating edematous volume reduction. Ladder‐shaped LVA may be a useful option when there are 3 lymphatic vessels and 1 vein in a surgical field. © 2013 Wiley Periodicals, Inc. Microsurgery 34:404–408, 2014.     

Morbidity of inguinal lymphadenectomy for invasive penile carcinoma

OBJECTIVE: To determine the incidence and the consequences of complications related to modified and radical inguinal lymphadenectomy in patients with invasive penile carcinoma, defined by invasion of the corpus spongiosum or cavernosum (> or =T2). MATERIALS AND METHODS: A total of 118 modified (67.0%), and 58 radical (33.0%) inguinal lymphadenectomy were performed in 88 patients between 1989 and 2000. To decrease the morbidity, radical inguinal lymphadenectomy was proposed only in patients with palpable inguinal lymph nodes, uni- or bilaterally (N1 or N2). Modified inguinal lymphadenectomy was performed bilaterally in patients with invasive penile carcinoma and non-palpable inguinal lymph nodes (N0), and unilaterally in the side without inguinal metastases in N1 patients. Complications were assessed retrospectively with a median follow-up of 46 months and classified as early (event observed during the 30 days after the procedure) or late (event present after hospitalisation or after the first months). RESULTS: A total of 74 complications after 176 procedures were recorded. After modified inguinal lymphadenectomy, 8 early (6.8%) and 4 late (3.4%) complications were observed. There were a total of 110 dissections with no complications and 8 dissections with 1 or 2 complications. After radical inguinal lymphadenectomy, the morbidity increased with 24 early (41.4%) and 25 late (43.1%) complications, observed in only 18 of 58 radical procedures. Leg oedema was the most common late complication, interfering with ambulation in 13 cases (22.4%). CONCLUSION: Modified inguinal lymphadenectomy, with saphenous vein sparing and limited dissection offers excellent functional outcome in patients with invasive penile carcinoma and nonpalpable inguinal lymph nodes. The morbidity after radical lymphadenectomy still significant, especially in patients with multiple or bilateral superficial inguinal lymph nodes treated by pelvic and bilateral inguinal lymphadenectomy.     

阴茎癌腹股沟淋巴结清扫术中保留大隐静脉能否减少术后并发症的系统评价

目的 探讨阴茎癌腹股沟淋巴结清扫术中保留大隐静脉能否减少术后并发症的发生.方法 在中国知网、万方、维普、中国生物医学文献数据库、Web of Science、PubMed、Co-chrane Library等电子数据库中进行阴茎癌腹股沟淋巴结清扫术相关文献检索,检索时限从建库至2017年4月1日.由2名研究者独立交叉阅读筛选及提取文献信息,第3名研究员对结果进行对比核查.结果 纳入符合标准的文献共39篇.开放腹股沟淋巴结清扫术组12篇(其中单纯保留大隐静脉组7篇,单纯切除大隐静脉组2篇,有3篇文献同时对比保留大隐静脉组及切除大隐静脉组),腹腔镜下腹股沟淋巴结清扫术组27篇(其中单纯保留大隐静脉组8篇,单纯切除大隐静脉组18篇,有1篇文献同时对比保留大隐静脉组及切除大隐静脉组).保留大隐静脉/不保留大隐静脉的开放腹股沟淋巴结清扫术病例的切口感染率、皮瓣坏死率、淋巴肿发生率、血清肿发生率、下肢水肿发生率差异均有统计学意义(P<0.05).保留大隐静脉/不保留大隐静脉的腹腔镜下腹股沟淋巴结清扫术病例的切口感染率、血清肿发生率、下肢水肿发生率差异亦有统计学意义(P<0.05).结论 无论在开放或是腹腔镜腹股沟淋巴结清扫术中,保留大隐静脉相对于不保留者能显著减少术后并发症的发生.     

Microsurgical lymphovenous anastomosis for treatment of lymphedema: a critical review

Lymphovenous anastomoses (LVA) offer ideal physiologic treatment for lymphedema, and our experimental data support late patency. Between Jan. 1, 1982, and April 1, 1986, 18 patients underwent operation for chronic lymphedema; LVA could be performed in 14 patients (10 women and four men). Six patients had secondary lymphedema of the upper extremity. One of eight patients with lymphedema of the lower extremity had filariasis, and seven had primary lymphedema. Mean follow-up was 36.6 months (range: 5 to 57 months). Limb circumference and volume, number of postoperative episodes of cellulitis, and lymphoscintigraphy were used to assess results. Improvement occurred in three upper extremities and two lower extremities. There was no change in five extremities, and in four patients the edema progressed. One patient with primary lymphedema and four of seven patients with secondary lymphedema improved. Only one of five patients benefited from one anastomosis; however, all patients with more than two anastomoses improved. Lymphoscintigraphy was performed in 10 patients. No lymphatic channel was visualized before operation in three patients, and at operation none was found. In four other patients lymph channels localized by lymphoscintigraphy were identified during operation. Significant improvement was documented by lymphoscintigraphy in one patient after operation, and this patient had permanent improvement 30 months later. Patients with primary lymphedema had disappointing results, but four of seven patients with secondary lymphedema benefited from LVA, especially if several anastomoses could be performed. Lymphoscintigraphy appears to be a suitable method of both identifying patent lymph channels before surgery and determining function of LVA after operation. However, presently objective data to prove the clinical efficacy of this operation are lacking.     

The use of sentinel lymph node biopsy in squamous cell carcinoma of the foot: a case report

Squamous cell carcinoma (SCC) is the second most common skin cancer in humans. Because the incidence of metastasis from SCC of the skin is rare, regional lymphadenectomy is generally not recommended for the patients with clinically node-negative disease. However, in patients with an intermediate and high risk of metastasis, evaluation of the lymph nodes to detect the absence of metastatic nodal disease is a difficult task. Here, we present a patient with a large SCC on the dorsum of the foot with clinically negative inguinal and popliteal lymph nodes. Intraoperative lymphatic mapping technique was used to make the decision of the inguinal node dissection. Two sentinel lymph nodes that were biopsy negative were found; therefore, only tumor excision was performed without adding complete inguinal node dissection. The defect was reconstructed with the free flap. After a 4-year carcinoma-free period, we determined that the pathology of the sentinel lymph nodes reflected that of the inguinal region.The use of selective lymphadenectomy technique in extremity SCC is very new. However, it might be useful in staging patients with SCC of the lower extremity by being able to detect absence or presence of occult metastatic nodal disease and avoid unnecessary complete inguinal node dissection.