Lymphoedema Evidence Library › Topics › Lower-limb and primary lymphoedema
Lower-limb and primary lymphoedema
Lower-limb and primary lymphoedema
16 sources
Evidence in one minute
- Lower-limb lymphatic microsurgery: no RCTs; LVA and VLNT both reduce volume (34–47%, very low certainty) and cellulitis (low certainty by GRADE, revised 2026-10-08 — guideline scale "moderate": −2.1 episodes/year after VLNT; 0.84→0.07/year after LVA). LVA when functional channels are seen on ICG at any stage; VLNT for advanced disease at higher morbidity. Immediate lymphatic reconstruction after pelvic/iliofemoral lymphadenectomy reduces leg lymphoedema by ~30 per 100 — but probably avoid after lower-limb melanoma/SCC. Gloviczki 2026
- Primary lymphoedema surgery: 485 patients in 55 series; complications LVA 1%, VLNT 13%, liposuction 11%, excision 46%. Very low certainty. Gaxiola-García 2024
- Exercise: international Delphi framework — 26 recommendations (resistance, aerobic, flexibility, compression during exercise). Davies 2026
- Wounds in lymphoedematous legs: Canadian 2025 recommendations. Keast 2025
- Amputation requests: a full specialist conservative trial can preserve the limb. Estfanous 2026
- Familial disease: patient narratives illustrate the hereditary pattern that should prompt genetic testing. Ziegler 2012
- Hosiery for leg lymphoedema: flat-knit for distorted shapes. Lymphoedema Framework ; senior editorial advisor Moffatt C 2006
Update 2026-10-08 — downloaded evidence
- After gynaecological cancer: leg lymphoedema 1–56% by cancer type; risks lymphadenectomy, node count, radiotherapy, BMI >25; surgical approach irrelevant; sentinel mapping protective. Decorte 2025 · Dessources 2020
Appraisal update 2026-10-09
- Single cases: conservative therapy averted a requested amputation (Estfanous 2026 — no data on age, stage or volumes); familial congenital leg lymphoedema worsened by infant Z-plasty (Ziegler 2012 patient account). Estfanous 2026 · Ziegler 2012
- Dessources 2020 (JBI 4/6): sentinel mapping figures are non-randomised comparisons. Dessources 2020
Gaps
No trials of conservative therapy specific to leg lymphoedema are held; no SA data on post-gynaecological or melanoma lymphoedema.
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 0 | 0 | 0 | 0 | 0 |
| Null or negative | 0 | 0 | 0 | 0 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.
All 16 sources
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