Browse NL.
The diagnostics and management of primary lymphedema.
J Vasc Surg 1986 Jan;3(1):181-4

Although the clinical features of lymphedema are often distinctive, it is
essential to confirm the diagnosis with an objective test. Isotope lymphography
is simple and 95% accurate for defining deficient lymph clearance. It is
particularly useful for separating venous from lymphatic edema. Definition of the
precise abnormality--peripheral lymphatic obliteration, proximal lymph node
obstruction, or valvular incompetence--can only be made with lymphangiography.
The mainstay of treatment is the reduction of edema by regular elevation and
massage and external compression with elastic stockings. Pneumatic leggings are
also helpful. Gross edema caused by peripheral obliteration may be reduced
surgically by simple excision (Homans' operation) or complete excision and skin
grafting (Charles' operation). Reflux through incompetent vessels may be
prevented by vessel ligation. Obstruction by the iliac lymph nodes may be
bypassed with an enteromesenteric pedicle.