Diagnosis and management of secondary lymphedema

Abstract

Secondary lymphedema, more common than its primary variant is essentially a clinical diagnosis. Evaluation should include measurement of limb circumference and volume and appropriate staging protocols to determine the severity of the condition. Imaging studies such as magnetic resonance imaging and lymphoscintigraphy are invaluable in ruling out other causes of extremity swelling and for planning surgical treatment. Conservative measures such as combined decongestive therapy are of prime importance in reducing the limb volume and should be continued to maintain the results of surgical treatment. Pharmacotherapy does not have much role in lymphedema. Surgical options which were initially restricted to debulking procedures in chronic late stages are now gaining more relevance with the advent of physiological techniques to prevent further progression of the condition. Detailed counseling regarding the chronic nature of the disease and the need for regular follow-up along with rehabilitation programs will further improve the management of lymphedema.