best practice for the management of lymphoedema ... - EWMA

ASSESSMENT
BOX 12 Severity of unilateral
limb lymphoedema 6
Mild:
40% excess limb volume
Chylous ascites: the accumulation
of chyle (fat-bearing lymph) in the
abdominal cavity
TABLE 2 Differentiating lymphoedema and lipoedema
Lymphoedema Lipoedema*
Classification of severity
One method of establishing the severity of
unilateral limb lymphoedema is based on the
difference in the limb volume of the affected
and unaffected limbs (Box 12).
There is currently no formal system for the
classification of the severity of bilateral limb
swelling or lymphoedema of the head and
neck, genitalia or trunk.
The severity of lymphoedema can also be
based on the physical and psychosocial
impact of the condition. Factors to consider
include:
■ tissue swelling – mild, moderate or severe;
pitting or nonpitting
■ skin condition – thickened, warty, bumpy,
blistered, lymphorrhoeic, broken or
ulcerated
ASSESSMENT
Signs and symptoms Can involve the legs, arms, trunk, Usually causes symmetrical
genitalia or head and neck bilateral swelling of the lower limbs;
Swelling of limbs affects hands and feet can occur in arms
Affects either sex Swelling stops at ankles and wrists
Stemmer sign may be positive; usually Pain and bruising are prominent
not painful on pinching features
Affects mainly women
In pure lipoedema, Stemmer sign is
negative; often painful on pinching
Aetiology Results from inadequate lymphatic Unknown; results in excessive
drainage subcutaneous fat deposition
May be congenital or result Appears to be oestrogen requiring
from damage to the lymphatic system and starts at time of hormonal
Not usually associated with change eg pregnancy, puberty
hormonal imbalances Family history of lipoedema often
positive
Lymphoscintigraphy Identifies disordered lymphatics Often indicates normal lymphatic
functioning
MRI scan Honeycomb pattern in the subcutis Subcutaneous fat, but no fluid
and thickened skin
*Lipoedema can progress to develop an oedematous component – lipolymphoedema.
■ subcutaneous tissue changes –
fatty/rubbery, nonpitting or hard
■ shape change – normal or distorted
■ frequency of cellulitis/erysipelas
■ associated complications of internal
organs, eg pleural fluid, chylous ascites
■ movement and function – impairment of
limb or general function
■ psychosocial morbidity.
A more detailed and comprehensive
classification applicable to primary and
secondary lymphoedema remains to be
formulated.
BEST PRACTICE FOR THE MANAGEMENT OF LYMPHOEDEMA 9