Lymphedema

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1.  Define the following:  primary lymphedema, secondary lymphedema, congenital, praecox, tarda, and Milroy's disease.  Which involve the deep lymphatic system?

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2.  What radiologic work-up is needed before you operate on a patient with lymphedema?

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3.  Read McCarthy's chapter about diuretics, benzopyrones, pumps, stockings, and physical therapy.  Do they work?

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4.  A patient is post-groin dissection and has had lymphedema for years.  She now consults you after she develops blue and red plaques on her leg.  What is this and what should you do?  What is the long-term outcome of this disease?

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5.  Discuss microlymphatic anastomoses.  (PRS 1977; 60:197, PRS 1990; 85:64)

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6.  Does liposuction work for lymphedema?  Does transposing muscle or omentum into this area work?

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7.  How does Thompson's dermal flap operation differ from the Miller/Sistrunk staged excision operation?

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8.  What are the Kondolean and the Charles procedures?  Who was Charles?  (PRS 1977; 60:859, PRS 1996; 98:1258)

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9. Do lymph node vein anastomoses work?

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10.  What are the most common causes of lymphedema worldwide?  What about the United States?

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11.  Discuss the treatment of scrotal lymphedema.

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12.  Does crossing an obstruction with a free flap relieve lymphedema?  (PRS 1997; 99:730)

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13.  What percentage of patients get arm lymphedema after mastectomy and axillary dissection?  When does it appear?  How should you treat it?

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