Lymphatic based edema (lymphedema) may be primary in origin (genetic) or secondary to a variety of causes including scar tissue from previous surgical incisions or radiation therapy, recurrent infections or chronic venous insufficiency. Primary lymphedema usually occurs earlier in life and often involves the dorsum of the feet and toes. Recurrent episodes of skin infections leading to systemic febrile illness are commonplace and require early intervention with antibiotic therapy, as well as long term therapy with elevation, manual compression wraps, compression hose and frequent, regularly scheduled periods of elevation.
Treatable superficial venous insufficiency is the single most common cause of lymphedema and occurs when chronic protein and water accumulation in the dermal layer of the skin scars the dermal lymphatics. As the venous hypertension persists, red and white blood cells leak through the thin walled veins into the dermal layer causing pigmentation and further scarring of the delicate lymphatic system. Correction of venous insufficiency may result in resolution of the dermal scarring and improvement of the lymphatic drainage and a reduction in the accumulation of extra-venous fluid. Ultrasound investigation to rule out venous insufficiency should be considered in all patients with the diagnosis of primary or secondary lymphedema.
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