The stages of lymphedema
| ISL stage and description | Campisi stage and description | Recommended treatment | |||
|---|---|---|---|---|---|
| Subclinical | 0 | No swelling, change only on imaging | |||
| Mild | I | Accumulation of fluid which subsides with limb elevation, usually lasts <24 h, Pitting may occur | Ia | No overt swelling despite impaired lymph drainage | LVA |
| Ib | Reversible swelling with limb elevation | ||||
| Moderate | IIa | Rarely resolves with limb elevation alone | II | Mild persistence of swellingwith elevation | LVA, VLNT |
| IIb | Loss of pitting to progression of dermal fibrosis | III | Persistent swelling with recurrent lymphangitis | VLNT, liposuction | |
| Severe | III | Lymphostatic elephantitiasis | IV | Fibrotic changes with column-like limb | VLNT, liposuction, excision |
| No pitting, development trophic skin change | V | Elephantiasis with limb deformation incdluding lymphostatic warts | |||
ISL: immediate lymphatic reconstruction, LVA: lymphaticovenular anastomosis, VLNT: vascularized lymph node transfer.