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A multidisciplinary approach to managing lymphorroea in primary lymphoedema: a case study

08 February 2024
Volume 33 · Issue 3


This case study describes the successful management of a patient with primary lymphoedema, who was experiencing lymphorrhoea and epidermolysis, using a multidisciplinary approach. The patient had Klippel–Trenaunay syndrome. The multidisciplinary team, in an outpatient clinic in Japan, included a certified lymphoedema therapist, plastic surgeons, and a wound, ostomy and continence nurse. The team performed complex physical therapy and lymphaticovenular anastomosis, which promoted the resolution of the lymphorrhoea. This resulted in improvements in skin condition, the prevention of recurrent cellulitis, and no increase in limb circumferences during the 1-year follow-up period. This report highlights the importance of a multidisciplinary approach to lymphoedema management, including lymphorrhoea control that fitted in with the patient's daily life. It is hoped that this article will contribute to the improvement of the quality of life of patients with lymphoedema.

This article reports on the successful management of a patient in her 40s who had been diagnosed with Klippel–Trenaunay syndrome at birth and was experiencing lower left extremity lymphoedema, lymphorrhoea, and cellulitis.

Klippel–Trenaunay syndrome is a congenital condition. The symptoms associated with the syndrome are port wine stains, varicose veins and hypertrophy (extra growth) of one limb. The port wine stain is usually visible at birth but the diagnosis may not be confirmed until the varicose veins and limb hypertrophy become more noticeable later (Great Ormond Street Hospital for Children NHS Foundation Trust, 2015).

Despite having a lymphoedema diagnosis in childhood and treatment using low-strength compression therapy, the patient had experienced worsening lymphorrhoea and epidermolysis in one limb after giving birth. Subsequently, she was referred to the lymphoedema outpatient clinic at an acute hospital. The patient had concerns regarding the extensive lymphorrhoea and epidermolysis, which affected her daily life, requiring frequent changes of clothes during the day. She also experienced anxiety associated with the sudden occurrence of cellulitis, which she had experienced before. She had a newborn baby and therefore wanted these clinical concerns related to lymphorrhoea to be resolved.

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