A 73-Year-Old with Lower Extremity Edema: A Comprehensive Approach to Lymphedema
A 73-year-old female was referred for long-standing lower extremity edema. She describes a feeling of heaviness and tightness in her legs with frequent episodes of cellulitis. Her comorbidities include medically complicated obesity, atrial fibrillation, hypertension, and degenerative arthritis in both knees. Her physical examination revealed bilateral lower extremity swelling that included the feet and toes. She has a positive "stemmer" sign with restricted range of motion in her legs with hardening and thickening of the skin (Figure 1). Complete blood count, chemistries, thyroid stimulating hormone, and liver function studies were normal. Venous ultrasound demonstrates patency of the great saphenous vein and small saphenous vein without reflux or incompetence. Sleep study was negative for apneic events. She was diagnosed with lymphedema and prescribed compression garments.
Which of the following is the best next step for someone who has lymphedema in the leg that does not respond to wraps or compression alone?