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Revisiting Lymphedema Staging: Heterogeneous Disease Severity within a Single Limb
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Background:
Lymphedema is a disease of the skin and subcutaneous tissue resulting from a disturbance in lymph flow. Anyone can be affected, and causes include cancer therapy when lymph nodes are removed or irradiated, the parasitic disease lymphatic filariasis, and damage caused by exposure to irritant soils known as podoconiosis. Manifest lymphedema is progressive and a major contributor to disability, stigma, and social isolation for affected people. Although the pathogenesis of connective tissue changes in lymphedema will follow a similar course regardless of the disease of causation, several systems are used to stage progression. Disparity in these staging systems leads to inconsistency in reporting of the severity of lymphedema and prevents meta-analysis of research results. In the global health environment, integrated morbidity management for chronic illness is essential to meet the needs of affected people and to be sustainable for health care systems. Clinical descriptors for staging criteria within each system may assist clinicians in assessment and provide a format for consistency in reporting by lymphedema researchers.
Methods and results:
Lymphedema staging systems used in oncology, filariasis, and podoconiosis settings were reviewed and the assessment techniques, diagnostic procedures, and clinical observations used by each system are described. The most commonly used staging systems are compared to identify similarities, and a matrix approach to lymphedema staging is proposed.
Conclusion:
A universal staging system would contribute to more consistent reporting of research on and clinical management of lymphedema arising from multiple causes.
Lymphedema is often diagnosed by its characteristic clinical presentation. In some cases, however, instrumental investigations are necessary to establish the diagnosis, particularly in early stages of the disease. One of the primary problems for microsurgery in treating lymphedema consists of the discrepancy between the excellent technical possibilities and the insufficient results in reduction of lymphedematous tissue fibrosis and sclerosis. Long-term results indicate that microsurgical operations have a valuable place in the treatment of obstructive lymphedema (primary or secondary) and should be the treatment of choice in these patients. Improved results can be expected with earlier microsurgical operations because patients referred earlier usually have less lymphatic disruption and fibrotic tissue. Advanced diagnostic methods and improvements in operation techniques have modified indications for surgical therapy of lymphedema. This article systematically reviews the published literature on the microsurgical treatment of lymphedema to the present.
The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the International Society of Lymphology
- Lymphology
Lymphedema and microsurgery
- Campisi
Lymphology Is. The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the International Society of Lymphology
Lymphology Is. The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the International Society
of Lymphology. Lymphology 2020;53:3-19.