Our center proposes a modified radical inguinal lymph node dissection, which ensures the scope of radical dissection to ensure tumor control while reducing complications. By understanding the key points of the procedure, patients can better achieve peace of mind and reassurance. The essence of this procedure is briefly as follows: 1. S-shaped incision is used. Compared with the traditional S-shaped incision for iliac inguinal lymph node dissection, the S-shaped incision used in this procedure is shorter and more oblique, and a 0-gauge silk suture is used for traction across the cut edge of the skin to provide better exposure and avoid excessive stretching of the flap during surgery. The blood supply to the inguinal region is derived from the superficial circumflex iliac artery, the external pubic artery, and the superficial inferior abdominal wall artery, all of which run parallel to the inferior inguinal ligament. The S-shaped incision designed for this procedure minimizes damage to these supply vessels, thus preserving the distribution of the penetrating arteries adjacent to the flap junction. In addition, the S-shaped incision reduces tension during suturing and allows for better healing of the incision. 2. Histological studies have shown that Camper’s fascia in the inguinal region is divided into superficial and deep layers by a thin dense band of connective tissue. Anatomical studies have shown that the blood supply to the whole inguinal flap is supplied by two arterial plexuses: the subcutaneous vascular plexus (superficial Camper’s fascia) and the deep fascial vascular plexus (deep Camper’s fascia), which are located below the cortex. The larger branches of the penetrating artery (femoral artery) form the deep fascial vascular plexus in the deep layer of Camper’s fascia, which gives off small ascending branches to communicate with the subcutaneous vascular plexus. In addition, the oblique branch from the penetrating artery does not participate in the formation of the deep fascial vascular plexus, but travels directly to the subcutis to participate in the formation of the subcutaneous vascular plexus. After removal of all lymphatic adipose tissue from the deep layer of Camper’s fascia, the deep fascial vascular plexus and the oblique branches of the artery were completely disrupted within the area of clearance, and the above-mentioned vascular network supplied the subcutaneous vascular plexus with blood flow. The initial flap blood supply after inguinal debridement is only supplied through the contiguous penetrating arterial vascular distribution area at the junction of the flap edge, which is in mutual communication with the subcutaneous vascular plexus of the free flap to ensure early ischemia-free necrosis. 3, Use anatomic landmarks to separate the flap in the correct plane. Previous literature has suggested that the correct plane is the key to reduce postoperative complications, but the method of how to find the correct plane has not been mentioned in the literature. After incision of the skin and subcutis, a white translucent membranous layer can be found between the superficial and deep layers of Camper`s fascia, which can be used as an anatomical landmark to accurately find the correct plane for flap separation. 4, Camper’s fascia in the inguinal region is divided into two layers. The subcutaneous vascular plexus is located in the superficial layer of Camper’s fascia, while the superficial group of inguinal lymph nodes to be cleared is located only in the deep layer of Camper’s fascia. The correct separation plane is located between the deep and superficial layers, and the flap is separated by the white translucent membranous layer, which can preserve the subcutaneous vascular plexus of the free flap and minimize damage to the blood supply of the flap, while ensuring the complete removal of the superficial group of lymphatic adipose tissue. Too thin a flap can disrupt the subcutaneous vascular plexus, (which forms a network of traffic vessels through the skin surrounding the flap) and lead to early ischemic necrosis due to lack of blood supply in the thin skin. The concept of preserving a thicker flap or preserving Scarpa’s fascia is often cited as the correct concept. In fact, Scarpa’s fascia is already fused to broad fascia at the inguinal ligament and there is no Scarpa’s fascia in the cleared area. The thicker flap inevitably retains some of the deep lymphatic fatty tissue of Camper`s fascia, with the possibility of residual metastatic lymphatic tissue, leading to recurrence. In addition, the vascular network of the deep layer of Camper`s fascia that remains below the white translucent membranous layer is destroyed and the blood supply is lost, leading to fat liquefaction and necrosis and infection. 5. Complete preservation of the broad fascia. The deep group of lymph nodes emanates directly from the superficial group of lymph nodes, usually located at the opening of the fossa ovalis. Embryological studies have shown that there is no lymphatic drainage of penile origin beneath the inferior border of the oval fossa and the broad fascia (a connective tissue about 3 mm thick) lateral to the femoral vessels. The septal fascia is a slightly thickened connective tissue derivative that covers the surface of the fossa ovalis and is of different embryologic origin than the broad fascia. The sieve fascia needs to be opened to clear the deep group of lymph nodes and to clear the lymphatic adipose tissue anterior and medial to the femoral vessels. The complete preservation of the broad fascia does not affect the tumor control effect, while protecting the microvascular network below the broad fascia and reducing the incidence of seroma and lymphatic cysts. In addition, the femoral vessels can be protected by the broad fascia coverage, thus eliminating the need for suturing muscle transposition to protect the femoral vessels. 6. Careful ligation of the peripheral lymphatic vessels, especially medially and inferiorly, is noted. After clearing the incision, the incision is flushed and 0# silk sutures are dotted to close the broad fascia with Camper’s fascia superficially to eliminate potential subcutaneous gaps while reducing tension during incision closure. A Pan’s porous drain was placed under the flap, with the lowest point of drainage being the lateral aspect of the external spermatic fascia above the medial aspect, and there were more intersecting lymphatic vessels here, so it was necessary to ensure unobstructed drainage here. When suturing the skin, avoid using toothed forceps to hold the flap, and avoid over-tightening the knot to close the skin incision. The postoperative drainage tube is connected to a continuous negative pressure continuous suction bottle to eliminate the potential gap between the flap and the broad fascia and to ensure continuous drainage. In conclusion, the modified radical inguinal lymph node dissection described in this procedure is characterized by three technical improvements: S-shaped incision, precise separation plane using membranous anatomic landmarks, and complete preservation of the broad fascia, which significantly reduce postoperative complications and ensure tumor control.