Assessment and Management of Extremity Lymphedema: Position Paper of WSRM

This position paper was developed by the World Society for Reconstructive Microsurgery Task Force on Lymphedema to establish consensus-based recommendations for the management of extremity lymphedema. The document addresses key domains of care, including assessment, treatment strategies, surgical interventions, and postoperative management, with the goal of providing practical and adaptable guidance applicable across diverse clinical settings. Effective management of extremity lymphedema requires a structured and standardized approach encompassing comprehensive evaluation, individualized treatment, and long-term follow-up. Initial assessment should include a detailed history and physical examination, supplemented by standardized limb circumference measurements and clinical photography to ensure objective and reproducible documentation. Imaging modalities, such as lymphoscintigraphy and indocyanine green (ICG) fluorescent lymphography, are essential for accurate disease characterization and surgical planning. Preoperative optimization with conservative therapy and compression remains a critical step prior to intervention. Surgical management should be tailored to disease severity and patient-specific factors, incorporating physiologic procedures—including lymphaticovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and lymphaticovenular anastomosis (LNVA)—as well as excisional techniques such as liposuction and direct excision when indicated. Postoperative care should include regular noninvasive assessments at three-month intervals and annual imaging to monitor outcomes. Long-term follow-up, extending up to five years, is recommended to ensure sustained clinical improvement and to guide ongoing management.