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Page 2 of 9 Neligan. Plast Aesthet Res 2021;8:45 https://dx.doi.org/10.20517/2347-9264.2021.39

lymphedema was caused by filaria. Whether the patient has spent time in an area where filariasis is endemic
is, therefore, something one needs to know. The duration of the condition is also important. We know that
the best results from lymphedema treatment are obtained early in the course of the disease. Duration will
also give an idea of how advanced the condition is likely to be, which may impact treatment. Cellulitis is a
common accompaniment of lymphedema, and each episode of cellulitis leads to further damage to the
[2]
lymphatic system . For this reason, a history of infection and its frequency is important. How does the
patient manage the swelling? Do they wear compression and, if so, is it effective? Finally, we want to know
what treatment the patient has had and, more importantly, how they responded to that treatment.

Physical examination
On completion of the history, the patient should be examined. There are several things that we look for
specifically in the patient with lymphedema:

1. How big is the limb and, if it is unilateral, how does it compare with the contralateral side?

2. Are there trophic skin changes? [Figure 1]

3. Is there any sign of infection?

4. Is there pitting edema? [Figure 2]

PATIENT ASSESSMENT
While all these modalities are assessed, no one alone is pathognomonic of lymphedema. However, taken
together, the information they give helps develop the diagnosis.

Limb circumference
Most practitioners measure limb circumference, and this is an important tool not only as a static evaluation
but also as a dynamic, ongoing measurement to assess the patient’s progress. However, limb circumference
needs to be standardized if it is to be of any use. So, the same measurement points need to be chosen.

Limb volume
Limb volume is of greater use than mere limb circumference measurements. Limb volume can, however, be
calculated from limb circumference measurements using the inverted cone formula. Brørson has published
the formula based on 4 cm increment measurements .
[3]

The traditional way of measuring limb volume was with water displacement. While this works, not every
clinic is equipped to do these measurements.

[4]
Optoelectronic volumetry using a Perometer is a very accurate way of measuring limb volume . Perometry
uses a frame with light transmitters on two sides and photo-sensors on the opposite sides. The limb to be
measured is placed within the frame, and the frame is moved along the limb to give a very accurate
measurement of the limb volume. Hands and feet are not measured using this technique.

Bio-impedence spectroscopy
This test measures the time taken for a small electrical current to pass through the tissues. It is based on the
premise that the amount of opposition to the flow of electrical current (impedance) through the body is
inversely proportional to the volume of fluid in the tissue.