title: Successful Management of Severe Unilateral Lower Extremity Lymphedema in an Outpatient Setting.
abstract: OBJECTIVE
  Non-cancer-related lymphedema is frequently unrecognized until it has advanced and, therefore, presents substantial management challenges. Treatment for lymphedema reflects cancer research and not the distinct complexities of non-cancer-related lymphedema. This case report describes an outpatient intervention for a patient with non-cancer-related unilateral lower extremity lymphedema.
  
  
  METHODS
  The patient was a 42-year-old woman who was morbidly obese and had left lower extremity chronic stage III lymphedema. Massive disfiguring lymphedema of her lower leg caused chronic wounds, pain, difficulty ambulating, and the inability to lift her leg in transfers. The patient received complete decongestive therapy (CDT) in an outpatient setting.
  
  
  RESULTS
  The volume of the patient's leg decreased more than 66%, so that her massive lower leg was transformed to nearly the same size as her unaffected limb. Proper compression management restored independent transfers and pain-free ambulation.
  
  
  CONCLUSIONS
  Delayed diagnosis and treatment of non-cancer-related lymphedema result in increased severity and impaired mobility, making this a unique, complex condition requiring modifications to CDT in the outpatient setting. This case report demonstrates successful outpatient treatment of a patient with severe unilateral lower extremity lymphedema associated with large wounds and impaired mobility using CDT that was modified to accommodate her complex medical status, transportation barriers, and health insurance availability. Following 23 weeks of physical therapist interventions, the patient's affected lower extremity was the same size as the unaffected lower extremity, and she was independent in ambulation and stair climbing.
authors.affiliation: T. Leard, PT, DPT, CLT, Leonardtown, Maryland. This work was done to satisfy the requirements of Dr Leard's transitional doctor of physical therapy degree at Shenandoah University, Winchester, Virginia. leardpt@gmail.com.
authors.forename: Teresa
authors.initials: T
authors.lastname: Leard
authors.affiliation: C. Barrett, PT, DPT, Dean Clinic, Janesville East, Janesville, Wisconsin.
authors.forename: Carrie
authors.initials: C
authors.lastname: Barrett
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D058128:Compression Bandages; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology / Q000628:therapy; D035002:Lower Extremity; D008209:Lymphedema / Q000150:complications / Q000628:therapy*; D008405:Massage; D051346:Mobility Limitation; D009767:Obesity, Morbid / Q000150:complications; D017592:Skin Care