LYMPHEDEMA 
This condition can be present by birth or due to different causes like
Trauma, parasite infection, tumor, surgical intervention etc.
SYMPTOMS 
Patient presents with swelling of the affected limb, skin changes, pain, difficulty in walking, and wearing
clothes etc.

DIAGNOSIS
Lymphoscintigraphy (a radiolabeled colloid is injected in skin and traced) shows the blockage in
lymphatic and helps in surgical intervention or MRI of affected limb
TREATMENT
1. CONSERVATIVE TREATMENT
Physiotherapy is the mainstay of the treatment
Ideally patient should be admitted for physiotherapy at specialized center but as there are lack of
resources in our country so we advise physiotherapy under supervision along with
Compression stockings/wraps
Local skin care with emollients and moisturizing creams
Maintaining hygiene,
Muscle pumping exercises
Massage therapy

2. SURGICAL TREATMENT 
Depending on the stage of the disease
It can be physiologic type or destructive type
Physiologic type involves lymphatic to venule bypass or lymph node transfer
Destructive type involves direct excision of skin and subcutaneous tissue or liposuction
HOSPITAL STAY AND ANESTHESIA
The physiologic procedures can be done under local anesthesia or general anesthesia and it can be a
daycare procedure or may need admission for 1-2 days at least.
For destructive type of procedures patient need to be admitted for at least 1-3 days for post operative
monitoring and usually done under general anesthesia.
Prognosis

Lymphedema is not a curable condition and patient has to live with it while continuing conservative
management. Surgical treatment just debulk the swollen limb. Newer techniques like lymphatic channel
to venule bypass and lymph node transfer added some benefits in the management of lymphedema but
might be not so effective in the long term.

 

Written by : Dr. Ali Adnan
Copyrights: Pakistan association of Plastic Surgeons