Posted by: patoconnor | October 29, 2008

Stages of Lymphedema



There are three basic stages active of lymphedema. The earlier lymphedema is recognized and diagnosed, the easier it is to successful treat it and to avoid many of the complications.

It is important as well to be aware that when you have lymphedema, even in one limb there is always the possibility of another limb being affected at some later time. This “inactive” period referred to as the latency stage. It is associated with hereditary forms of lymphedema.


Lymphatic transport capacity is reduced
No visible/palpable edema
Subjective complaints are possible

(Reversible Lymphedema)
Accumulation of protein rich edema fluid
Pitting edema
Reduces with elevation (no fibrosis)

(Spontaneously Irreversible Lymphedema)
Accumulation of protein rich edema fluid
Pitting becomes progressively more difficult
Connective tissue proliferation (fibrosis)

(Lymphostatic Elephantiasis)
Accumulation of protein rich edema fluid
Non pitting
Fibrosis and sclerosis (severe induration)
Skin changes (papillomas, hyperkeratosis, etc.)


Stage 1 (mild) – Upon waking in the morning the limb or affected area is almost a normal size. The tissue is still in a “pitting stage” ( when pressed by a finger the area indents and holds the indentation).

Stage 2 (moderate) – The tissue is “non-pitting” (when pressed by a finger the tissue bounces back without leaving an indentation). The tissue has a spongy consistency.

Stage 3 (severe) – The tissue at this stage is hard (fibrotic) and will be only slightly responsive to the touch. The swelling is almost irreversible and the limb is very large and swollen. Infections are possible at any stage of lymphedema but occurrence becomes greater as stages progress. A swollen limb, left untreated, becomes hard (fibrotic) and full of lymph fluid which is high in protein and a perfect medium for bacteria and infections.


03/10/04 Proposed

Discussion Stage Four:

There have been some voices raised about a Stage Four classification for lymphedema. From my personal experiences, I concur. Both my legs are classified as Stage Three, yet the difference between the two is very dramatic.

Stage Four Classification

The limb is so densely fibrotic that it is not possible to make any indentation when pressed. It becomes impossible for ultrasound testing to pick even the blood pulse. The skin becomes brittle and
even the slight of bumps causes a serious, extensively weeping wound.
Because of the hardness of the tissue, it has become a total septic foci for bacteria and constant cellulitis and systemic infections become the norm. The only treatment for cellulitis is an extended period of IV antibiotics.

There is no treatment option for Stage Four. The complete focus is on management, containment of infections, prevention if at all possible of amputation.




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