Dustmann HO.
[Diagnosis, differential diagnosis and therapy of lymphedema]
[Article in German]
Z Orthop Ihre Grenzgeb 1982 Feb;120(1):76-82

Swellings in the legs, caused by lymphedema, are encountered quite frequently in
everyday orthopedic practice. The swellings are hard, pale in color and usually
painful. Swellings of this kind occasionally atrain a completely disproportionate
size and are the referred to as elephantiasis. Lymphedemas fall into two
categories: 1. Congenital lymphedemas. These comprise lymphedemas occuring as a
result of aplasias or dysplasias of lymph vessels. 2. Acquired lymphedemas: In
such cases the edema may be due to mechanical causes, or it may be the result of
a disturbance of lymph drainage, e.g., due to the destruction of lymph vessels by
metastases, following extirpation of lymph nodes and radiation therapy; or it may
be the result of inflammatory processes, e.g., following erysipelas, in
filariasis or after a wound infection. Four stages of lymphedema are also
distinguished: Stage I - latent lymphedema Stage II - reversible lymphedema Stage
III - irreversible lymphedema Stage IV - Elephantiasis. Apart from clinical
diagnosis the most comprehensive and reliable diagnostic procedure is
lymphangiography. A simple and well-tried method of diagnosing lymphedema is to
inject lymphotropic dye subcutaneously. The technique is outlined. The
differential diagnosis of lymphedema is described. With regard to treatment,
reference is made to surgical possibilities. However, these do not always augur
success and the complication rate is high. Massive lymphedemas, therefore, are
usually treated conservatively, by Van der Molen's tube method, with intermittent
cuff pressure (pressure-curve therapy) and manual lymph drainage. The various
treatment methods are described and some of the disadvantage and risks involved
are pointed out.