The incision described above is a departure from the incision usually described in that it is more conservative and definitely plans penile and scrotal flaps out of the normal integument that previously was found in pubic and suprapubic regions and in the upper thigh, which integument has been pulled down over elephantoid tissue by the weight of the tumor. This integument often covers elephantoid tissue but in general itself is normal.
The fact that elephantoid tissue may be found beneath this skin does not render it useless or dangerous as a covering for penis and testicles. Were there any danger of recurrence of the elephantoid process its recurrence would not be due to any skin used but rather to the failure of any operation for elephantiasis of the scrotum to get at the real cause of the disease. This cause lies in the obstucted lymphatic system higher up and not in the skin used. However, should the skin within the areas mentioned above appear definitely thickened it can not be used and one is forced to resort to the more tedious procedures such as Thiersch grafting of the penis and pedicle grafting or undercutting of the thigh to produce a scrotum.