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Clinical staging and conservative management of peripheral lymphedema

Emile R Mohler III, MD
Babak Mehrara, MD
Section Editors
John F Eidt, MD
Russell S Berman, MD
Joseph L Mills, Sr, MD
Deputy Editors
Kathryn A Collins, MD, PhD, FACS
Diane MF Savarese, MD


Lymphedema is defined as accumulation of fluid and fibroadipose tissues due to disruption of lymphatic flow. Lymphedema can be primary (congenital lymphedema, lymphedema praecox, lymphedema tarda) or more commonly secondary (ie, acquired) (table 1). The main underlying causes of secondary lymphedema include interruption of lymphatics by surgery and/or radiation therapy (RT), malignant obstruction of the lymphatics, and infection. Lymph node dissection and/or radiation of the axilla or groin region for breast cancer or melanoma are the most common causes of secondary lymphedema in developed countries, while filariasis is the most common cause of secondary lymphedema worldwide.

Conservative, multimodal therapy for lymphedema consists of general measures for monitoring and self-care, which are applicable to all stages of lymphedema, along with varying levels of compression therapy and physiotherapy, with the choice of specific management dependent upon the clinical stage of disease (mild, moderate, severe).

Conservative therapies for managing lymphedema based upon its clinical severity are reviewed here. The clinical manifestations and diagnosis of lymphedema, and surgical treatment of lymphedema are discussed separately. (See "Clinical features and diagnosis of peripheral lymphedema" and "Surgical treatment of primary and secondary lymphedema".)


We suggest use of the staging system of the International Society of Lymphology (ISL) to characterize the severity of lymphedema. ISL staging ranges from 0 to III, and involves two criteria: the "softness" or "firmness" of the limb (reflecting fibrotic soft tissue changes) and the outcome after elevation. Within stages I through III, severity based upon volume differences is assessed as mild (<20 percent increase), moderate (20 to 40 percent increase), or severe (>40 percent increase). Stage "0" lymphedema is a subclinical or latent condition where swelling is not evident despite impaired lymphatic transport.

Several other classification systems are also used to describe the severity of lymphedema, including those of the American Physical Therapy Association (APTA) and the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) [1,2]. These schemes generally only refer to the physical condition of the extremity. Classifications that may also include physiologic or genotypic information are evolving [3].


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Literature review current through: Sep 2016. | This topic last updated: Jan 22, 2016.
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