This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (23)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Hematology/ Hematologic Malignancies  • Alert me on articles by topic  Social Bookmarking   What's this?

Alok Tiwari, MRCSEd; Koon-Sung Cheng, FRCS; Matthew Button, MRCS; Fiona Myint, FRCS; George Hamilton, FRCS

Arch Surg. 2003;138:152-161.

Hypothesis  The causes and management of lower limb lymphedema in the Western population are different from those in the developing world.

Objective  To look at the differential diagnosis, methods of investigation, and available treatments for lower limb lymphedema in the West.

Data Source  A PubMed search was conducted for the years 1980-2002 with the keyword "lymphedema." English language and human subject abstracts only were analyzed, and only those articles dealing with lower limb lymphedema were further reviewed. Other articles were extracted from cross-referencing.

Results  Four hundred twenty-five review articles pertaining to lymphedema were initially examined. This review summarizes the findings of relevant articles along with our own practice regarding the management of lymphedema.

Conclusions  The common differential diagnosis in Western patients with lower limb swelling is secondary lymphedema, venous disease, lipedema, and adverse reaction to ipsilateral limb surgery. Lymphedema can be confirmed by a lymphoscintigram, computed tomography, magnetic resonance imaging, or ultrasound. The lymphatic anatomy is demonstrated with lymphoscintigraphy, which is particularly indicated if surgical intervention is being considered. The treatment of choice for lymphedema is multidisciplinary. In the first instance, combined physical therapy should be commenced (complete decongestive therapy), with surgery reserved for a small number of cases.

From the University Department of Surgery, Royal Free Hospital National Health Service (NHS) Trust (Drs Tiwari, Cheng, Button, Myint, and Hamilton); and North Middlesex University Hospital NHS Trust (Dr Myint), London, England.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of Surgery
Arch Surg. 2003;138(2):125.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial
Kozanoglu et al.
Clin Rehabil 2009;23:117-124.
ABSTRACT  

Is there a risk for lymphatic complications after endovenous laser treatment versus cryostripping of the great saphenous vein? A prospective study
Disselhoff et al.
Phlebology 2008;23:10-14.
ABSTRACT | FULL TEXT  

Lymphedema of the Lower Extremity: Is It Genetic or Nongenetic?
Shinawi
CLIN PEDIATR 2007;46:835-841.
ABSTRACT  

Quantitative imaging of lymph function
Sharma et al.
Am. J. Physiol. Heart Circ. Physiol. 2007;292:H3109-H3118.
ABSTRACT | FULL TEXT  

Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: evaluation of extremity lymphoedema
Scarsbrook et al.
Br. J. Radiol. 2007;80:219-226.
ABSTRACT | FULL TEXT  

Elephantiasis nostras verrucosa.
Yoho et al.
J. Am. Podiatr. Med. Assoc. 2006;96:442-444.
ABSTRACT | FULL TEXT  

Approach to Leg Edema of Unclear Etiology
Ely et al.
J Am Board Fam Med 2006;19:148-160.
ABSTRACT | FULL TEXT  

Breast Cancer-Related Lymphedema
Morrell et al.
Mayo Clin Proc. 2005;80:1480-1484.
ABSTRACT