Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive, non-pitting edema of the [affected limb]. History of [surgical/radiation/trauma] intervention. Patient reports limb heaviness, tightness, and recurrent episodes of cellulitis. Symptoms are persistent, do not resolve with elevation, and demonstrate positive Stemmerโs sign.
Clinical Examination Findings
Physical examination reveals Stage II lymphedema characterized by fibrosis and tissue induration. Limb circumference measurements show significant discrepancy compared to the contralateral side. Skin changes include hyperkeratosis, papillomatosis, and loss of normal skin folds. Stemmerโs sign is positive. No signs of acute infection or venous insufficiency.
Treatment Protocol
Initiate Complete Decongestive Therapy (CDT) including manual lymphatic drainage (MLD), multi-layer compression bandaging, and therapeutic exercise. Prescribe custom-fitted compression garments (Class II/III). Monitor for skin integrity and infection. Consider surgical consultation for lymphovenous anastomosis (LVA) or vascularized lymph node transfer (VLNT) if conservative measures fail.