Successful Management of Severe Unilateral Lower Extremity Lymphedema in an Outpatient Setting.

BACKGROUND AND PURPOSE: Non-cancer-related lymphedema is frequently unrecognized until it has advanced and, therefore, presents substantial management challenges. Treatment for lymphedema reflects cancer research and not the distinct complexities of non-cancer-related lymphedema. This case report describes an outpatient intervention for a patient with non-cancer-related unilateral lower extremity lymphedema.

CASE DESCRIPTION: The patient was a 42-year-old woman who was morbidly obese and had left lower extremity chronic stage III lymphedema. Massive disfiguring lymphedema of her lower leg caused chronic wounds, pain, difficulty ambulating, and the inability to lift her leg in transfers. The patient received complete decongestive therapy (CDT) in an outpatient setting.

OUTCOMES: The volume of the patient's leg decreased more than 66%, so that her massive lower leg was transformed to nearly the same size as her unaffected limb. Proper compression management restored independent transfers and pain-free ambulation.

DISCUSSION: Delayed diagnosis and treatment of non-cancer-related lymphedema result in increased severity and impaired mobility, making this a unique, complex condition requiring modifications to CDT in the outpatient setting. This case report demonstrates successful outpatient treatment of a patient with severe unilateral lower extremity lymphedema associated with large wounds and impaired mobility using CDT that was modified to accommodate her complex medical status, transportation barriers, and health insurance availability. Following 23 weeks of physical therapist interventions, the patient's affected lower extremity was the same size as the unaffected lower extremity, and she was independent in ambulation and stair climbing.