There are three basic stages active of lymphedema. The earlier lymphedema is recognized and diagnosed, the easier it is to successful treat it and to avoid many of the complications.
It is important as well to be aware that when you have lymphedema, even in one limb there is always the possibility of another limb being affected at some later time. This “inactive” period referred to as the latency stage. It is associated with hereditary forms of lymphedema.
LATENCY STAGE or STAGE 0
Lymphatic transport capacity is reduced No visible/palpable edema Subjective complaints are possible
STAGE I
(Reversible Lymphedema) Accumulation of protein rich edema fluid Pitting edema Reduces with elevation (no fibrosis)
STAGE II
(Spontaneously Irreversible Lymphedema) Accumulation of protein rich edema fluid Pitting becomes progressively more difficult Connective tissue proliferation (fibrosis)
STAGE III
(Lymphostatic Elephantiasis) Accumulation of protein rich edema fluid Non pitting Fibrosis and sclerosis (severe induration) Skin changes (papillomas, hyperkeratosis, etc.)
STAGE IIII
The limb is so densely fibrotic that it is not possible to make any indentation when pressed. It becomes impossible for ultrasound testing to pick even the blood pulse. The skin becomes brittle and even the slight of bumps causes a serious, extensively weeping wound. Because of the hardness of the tissue, it has become a total septic foci for bacteria and constant cellulitis and systemic infections become the norm. The only treatment for cellulitis is an extended period of IV antibiotics.
There is no treatment option for Stage Four. The complete focus is on management, containment of infections, prevention if at all possible of amputation.
Stage four information is strictly my own thinking as many do not yet recognize as Stage Four, while others have even mentioned a stage Five.
A new staging system has been set forth by Lee, Morgan and Bergan and endorsed by the American Society of Lymphology. This provides a clear technique which can be employed by clinical and laboratory assessments to more accurately diagnose and prescribe therapy for lymphedema. In this improved version, four stages are identified (I-IV). Physicians and researchers can use additional laboratory assessments, such as bioimpedance, MRI, or CT, to build on the findings of a clinical assessment (physical evaluation). From this, results of therapy can be accurately be determined and reported in documentation, as well as research.
Treatment of Leg Lymphedema
The treatment for arm lymphedema is much the same as treatment for leg lymphedema. The preferred treatment is decongestive therapy.
