Warren AG, Brorson H, Borud LJ, Slavin SA, et al.
Annals of plastic surgery. Date of publication 2007 Oct 1;volume 59(4):464-72.
1. Ann Plast Surg. 2007 Oct;59(4):464-72.
Lymphedema: a comprehensive review.
Warren AG(1), Brorson H, Borud LJ, Slavin SA.
Author information:
(1)Harvard Medical School, Boston, MA, USA.
Comment in
Ann Plast Surg. 2008 Feb;60(2):228.
BACKGROUND: Lymphedema is a chronic, debilitating condition that has
traditionally been seen as refractory or incurable. Recent years have brought new
advances in the study of lymphedema pathophysiology, as well as diagnostic and
therapeutic tools that are changing this perspective.
OBJECTIVE: To provide a systematic approach to evaluating and managing patients
with lymphedema.
METHODS: We performed MEDLINE searches of the English-language literature (1966
to March 2006) using the terms lymphedema, breast cancer-associated lymphedema,
lymphatic complications, lymphatic imaging, decongestive therapy, and surgical
treatment of lymphedema. Relevant bibliographies and International Society of
Lymphology guidelines were also reviewed.
RESULTS: In the United States, the populations primarily affected by lymphedema
are patients undergoing treatment of malignancy, particularly women treated for
breast cancer. A thorough evaluation of patients presenting with extremity
swelling should include identification of prior surgical or radiation therapy for
malignancy, as well as documentation of other risk factors for lymphedema, such
as prior trauma to or infection of the affected limb. Physical examination should
focus on differentiating signs of lymphedema from other causes of systemic or
localized swelling. Lymphatic dysfunction can be visualized through
lymphoscintigraphy; the diagnosis of lymphedema can also be confirmed through
other imaging modalities, including CT or MRI. The mainstay of therapy in
diagnosed cases of lymphedema involves compression garment use, as well as
intensive bandaging and lymphatic massage. For patients who are unresponsive to
conservative therapy, several surgical options with varied proven efficacies have
been used in appropriate candidates, including excisional approaches,
microsurgical lymphatic anastomoses, and circumferential suction-assisted
lipectomy, an approach that has shown promise for long-term relief of symptoms.
CONCLUSIONS: The diagnosis of lymphedema requires careful attention to patient
risk factors and specific findings on physical examination. Noninvasive
diagnostic tools and lymphatic imaging can be helpful to confirm the diagnosis of
lymphedema or to address a challenging clinical presentation. Initial treatment
with decongestive lymphatic therapy can provide significant improvement in
patient symptoms and volume reduction of edematous extremities. Selected patients
who are unresponsive to conservative therapy can achieve similar outcomes with
surgical intervention, most promisingly suction-assisted lipectomy.
DOI: 10.1097/01.sap.0000257149.42922.7e
PMID: 17901744 [Indexed for MEDLINE]
