title: Lymphedema: a comprehensive review.
abstract: 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.
authors: Harvard Medical School, Boston, MA, USA.
authors: Anne G
authors: AG
authors: Warren
authors: Håkan
authors: H
authors: Brorson
authors: Loren J
authors: LJ
authors: Borud
authors: Sumner A
authors: SA
authors: Slavin
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery; D006801:Humans; D008208:Lymphatic System / Q000503:physiopathology; D008209:Lymphedema / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D061305:Lymphoscintigraphy; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012307:Risk Factors