Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about lymphedema.

And you can find written notes on this topic at zero definals.com slash lymphedema

or in the vascular surgery section of the Zero to finals surgery book. So let's get straight

into it. Linfidema is a chronic condition caused by impaired lymphatic drainage of an area.

The lymphatic system is responsible for draining excess fluid from the tissues. The tissues in areas affected by an impaired lymphatic

system becomes swollen with excess protein-rich fluid, and this is called lymphodema. The lymphatic

system also plays an important role in the immune system. Areas of lymphedema are more prone to infection. Primary lymphodema is a rare

genetic condition which usually presents in patients before the age of 30. It's the result of faulty development

of the lymphatic system. Secondary lymphedema is due to a separate condition that affects the lymphatic system.

The most common example is when a patient develops lymphodema after breast cancer surgery

due to removal of the auxiliary lymph nodes in the armpit.

Lipodema is an important differential diagnosis and this is where there's an abnormal build-up of fat

tissue in the limbs, often the legs. The feet are spared in lipidema, so lipidema doesn't affect the

feet, whereas lymphodema does affect the feet. Lipidema affects women more often than men.

It can cause pain, psychological distress,

and significantly affect the patient's quality of life.

Let's talk about the assessment of lymphodema.

Stemmer's sign can be used to assess for lymphedema.

The skin at the bottom of the second toe or the middle finger

is gently pinched together using two fingers.

If it's possible to lift and tent the skin,

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