Chronic lymphedema often turns into cellulitis in patients with diabetes. What is the preferred treatment?—PAULA JAUERING, ARNP, Leavenworth, Kan.

The diagnosis of lymphedema is usually made based on clinical presentation and history. Imaging studies may also be used for diagnosis and evaluation of treatment; lymphoscintigraphy is considered the gold standard. Duplex ultrasound, CT, and MRI may also be used. Conservative physiotherapy treatments include complex or complete decongestive therapy (which incorporates manual lymphatic drainage, compression bandages, myolymphokinetic exercises, skin care, and precautions during daily activities) and pneumatic compression, also referred to as pressure therapy. Pneumatic compression utilizes a segmental air pump to fill air chambers (gloves or boots) that provide pressure to the edematous limb. Newer techniques include high-voltage electrical stimulation (which reduces lymphedema by producing muscle contractions and relaxation that increase venous and lymphatic flow) and laser therapy (which reduces fibosis and stimulates lymphangiogenesis, lymph activity, lymphatic movement, macrophages, and the immune system). Surgical therapies for patients in whom conservative therapy was not effective may include resection procedures, microsurgical interventions, and liposuction. For more information, see Rev Lat Am Enfermagem. 2009;17:730-736 and Ann Plast Surg. 2007;59:464-472.—Philip R. Cohen, MD (140-6)

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