CHASCIP — Charles Excision and Bilateral Lymphatic SCIP Flap Transfer
CHASCIP combines excision of advanced penoscrotal lymphedema with bilateral pedicled lymphatic superficial circumflex iliac artery perforator (SCIP) flaps. Ciudad and colleagues reported eight men with ISL stage III disease in 2025. This is an early reconstructive option; comparative superiority and durable freedom from recurrence have not been established.[1]
The broader assessment and alternatives are covered in Genital Lymphedema, Complex Decongestive Therapy, Debulking Scrotoplasty, and 3R / SCIP-LFT.
Clinical role
Excision can relieve the mechanical burden of fibrotic genital enlargement, while a vascularized flap provides coverage and may support lymphatic drainage. These aims should be assessed separately. Neither a functioning flap nor successful debulking proves normal lymphatic transport or eliminates the need for follow-up.[2][3]
Selection depends on symptoms, tissue fibrosis, the available skin envelope, remaining lymphatic pathways, groin vascular anatomy, prior surgery or radiation, and the response to conservative care. ISL stage alone does not select a named operation. Extensive disease may require excision; functioning collectors may permit a lymphatic bypass, and healthy local skin may permit a simpler reconstruction.[2][3]
Planning and operative boundaries
- Define the penile and scrotal defects separately. Preserve the urethra, erectile structures, testes, spermatic cords, and viable tissues; use the required extent of excision rather than an automatic instruction to remove every tissue layer to a fixed depth.[3]
- Map the proposed flap's blood supply and relevant lymphatic pathways. Previous groin surgery, lymphadenectomy or radiation can affect feasibility.[2][3]
- Distinguish a lymphatic-vessel-bearing SCIP flap from a flap deliberately incorporating lymph nodes. These are different designs. Routine inclusion of superficial inguinal nodes is not a requirement for every lymphatic SCIP reconstruction; donor-leg drainage must be protected.[2][3]
- Choose penile graft or flap coverage according to the actual defect, donor condition and reconstructive plan. The penis also has lymphatic drainage; it should not be described as a site where lymphatic function is unimportant.[3]
The reported operation used bilateral pedicled flaps. This page does not prescribe a graft thickness, fixed donor site, node-harvest template or pedicle dissection from that report. For general excision and coverage principles, see Modified Charles Procedure and Penile Skin Grafting.[1]
What the initial series establishes
| Reported observation | Interpretation |
|---|---|
| Eight patients; mean follow-up 34 months | Small uncontrolled experience |
| Two postoperative complications: seroma with dehiscence, and partial skin-graft loss | Complications occurred in 2/8; severity and risk should not be ranked against unrelated series |
| No recurrence observed | Follow-up observation, not proof of cure |
| Mean Genital Lymphedema Score decreased from 6.6 to 0.6 | Suggests symptom improvement; does not isolate the contribution of the flaps from excision |
These findings come from the index report.[1] Operative time, blood loss and symptom scores cannot establish superiority over 3R, excision alone or another reconstruction across unmatched series. Two flaps also do not demonstrate twice the lymphatic capacity.
Follow-up
Assess wound and graft healing, flap perfusion, donor-site symptoms, recurrent swelling or lymphorrhea, cellulitis, urinary and sexual function, and the ongoing need for compression or other conservative treatment. Record patient-reported benefit and recurrence over time; do not promise compression independence or complete sexual-function recovery.[2][3]
References
1. Ciudad P, Escandón JM, Escandón L, Mayer HF, Manrique OJ. Surgical management of genital lymphedema using the combined Charles' procedure and lymphatic superficial circumflex iliac artery perforator flap transfer (CHASCIP). Microsurgery. 2025;45(5):e70075. doi:10.1002/micr.70075
2. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2023 consensus document. Lymphology. 2023;56:133–151. Full consensus.
3. Sun JM, Yamamoto T. Genital elephantiasis: surgical treatment and reconstruction. J Chin Med Assoc. 2024;87(2):142–147. doi:10.1097/JCMA.0000000000001021