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For further information, see CMDT Part 14-19: Lymphedema
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Essentials of Diagnosis
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Painless persistent edema of one or both lower extremities, primarily in young women
Pitting edema without ulceration, varicosities, or stasis pigmentation
Lymphangitis and cellulitis may occur
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General Considerations
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Primary lymphedema
Secondary lymphedema involves inflammatory or mechanical lymphatic obstruction due to
Secondary dilation of the lymphatics occurs in both forms and leads to incompetence of the valve system, which
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T2-weighted MRI to identify lymphatics and proximal obstructing masses
Lymphangiography and radioactive isotope studies may identify focal defects in lymph flow but are of little value in planning therapy
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No effective cure; treatment strategies are to control lymphedema and allow normal function
Antibiotic therapy (and periods of elevation) for secondary infection should cover Staphylococcus and Streptococcus organisms (Table 32–6)
Prophylactic antibiotics have not been shown to be of benefit
Diuretic therapy: intermittent courses are rarely helpful
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Therapeutic Procedures
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Intermittent elevation of the extremity, especially during the sleeping hours (foot of bed elevated 15–20 degrees by placing pillows beneath the mattress)
Constant use of graduated elastic compression stockings
Massage toward the trunk, either manually or with pneumatic pressure devices
Good hygiene and treatment of any trichophytosis of toes to avoid secondary cellulitis
Wound care centers specializing in the care of lymphedema may be helpful
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