What are the four stages of lymphedema?
Stage Zero. In Stage Zero, there are no clinical signs of lymphedema. The patient may indicate that something is wrong, or their limb feels heavy. If they just went through surgery, you can expect that something's going to feel not quite right. If you have access to imaging of the lymphatic system, you would be able to see the blockage. A little later on in the presentation, I'm going to show you images of the lymphatic system so you can see what a blockage looks like. At the University of Texas in Houston, they were doing surgery with a patient who had breast cancer and she said, "There's something wrong. My limb feels very heavy." They conducted this diagnostic imaging, they saw the blockage, and they immediately started lymphedema treatment. As a result of their prompt attention, she never developed lymphedema.
Stage One. Stage One has swelling present, but it resolves on its own. Perhaps in the morning, when the person has been asleep all night, we don't see any swelling. However, when they're on their feet all day, we see some swelling by the end of the day. Then, when they go to bed and they put their feet up, the swelling resolves. Swelling with orthopedic patients in Stage One usually is pitting edema. It's at an early stage, and it responds well to exercise, compression, manual lymphatic drainage, and all the other things that are in our lymphedema treatment toolkit.
Stage Two. Stage Two lymphedema involves swelling that does not resolve on its own and requires some sort of intervention to help reduce the swelling. We may see this in our patients with orthopedic problems. Not only do they need the orthopedic protocols, but they also need some lymphedema management. They do present with pitting edema. Our goal is to try our best to avoid it turning into this hard lymphedema where the lymph fluid turns more gel-like. At the same time, we need to be mindful of the surgical scar and the risk of infection. We want to make sure that any kind of swelling is neither lymphedema nor infection.
Stage Three. Rarely do we see Stage Three lymphedema with our orthopedic patients. Stage Three is a chronic form of lymphedema characterized by enormous swelling, called elephantiasis. The skin cannot contain all this lymph fluid, resulting in lobules, or huge globs of skin. The skin cells die, they turn black, and to touch the skin, it feels like you are touching the bark of a tree. People with Stage Three lymphedema have wounds and lymph leakage. Again, this is seen much more commonly in cancer patients and more rarely in orthopedic patients.