Towards an effective management of chronic lymphedema.

Lymph conduit perturbation causes lymph stasis and the local accumulation of interstitial fluid. Lymphedema, a chronic and debilitating disorder, remains incurable despite the advances in the description of its pathomechanism and the improvement of conservative and nonsurgical treatments. The gold standard of lymphedema treatment is multicomponent decongestive physiotherapy. Manual lymph drainage, compression bandaging, skin care, and exercises constitute the therapeutic regimen that could be adjusted with intermittent pneumatic compression. Prophylaxis could give a major benefit to risk group patients; however, the assessment of preventive approaches postulates further clinical trials. Surgery represents an emerging stakeholder in lymphedema care, although, the partnership with adjunctive nonsurgical therapy is still alive. Liposuction proved to be one of the most promising technique with the clearance of the lymph stasis-related adipose tissue. Regeneration of lymphatic tunnels with lymphovenous anastomoses or the transplantation of lymph vessels or small veins is based on long-term experience. The success of lymph node transplantation is still under evaluation, but this novel technique has produced notable improvements.