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Lymphedema: Diagnosis and Treatment


Lymphedema is a disabling condition. Primary lymphedema includes a spectrum of conditions that in the past have been described based on the timing of their presentation. Secondary lymphedema occurs as a result of any form of damage to the lymphatic system. It is important to understand the pathophysiology of the patient’s condition, and in order to do this, one must have a knowledge of the lymphatic system. New developments are occurring, and it is important to stay abreast of these. Assessment of the patient is paramount. This includes a full history as well as a physical examination. Several different types of assessment are commonly utilized. None of these is a stand-alone pathognomonic sign of lymphedema, but taken together, they not only provide a useful picture on initial presentation but are useful for ongoing assessment of the patient and of their response to treatment. Imaging is a vital part of the assessment and can point toward the most efficacious form of management. Conservative treatment has been the mainstay of treatment in the past and remains an important aspect of care both before and after surgery. There are two approaches to surgery for lymphedema. The traditional one has been an excisional procedure, and this is still valid for certain patients. Reconstruction can be achieved in certain patients by lymphaticovenous bypass (LVB), in others by vascularized lymph node transplant (VLNT). Some patients can benefit from both. There also appears to be a role in prophylactic lymphatic reconstruction in patients who are having an axillary or inguinal lymph node dissection. My current algorithm for management will be presented.

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