Abstract The diagnosis of elephantiasis of both lower limbs was made in a 39 year old woman after a fourteen year history of essential lymphoedema accompanied by hypoproteinaemia of 37 g/l. Complete excision of the diseased tissues was performed from the knees down with resection of the aponeuroses and cover by skin grafts raised from the legs at the start of the operation. A good result was observed after three years. After reviewing the literature, the authors recall the essential features of primary lymphoedema of the lower limbs.