Acquired Lymphedema: Abnormal Fluid Clearance Engenders Tissue Remodeling

The biology of lymphedema is complex. ¹ The appearance of lymphatic edema invokes complex biological alterations. ² Many of these changes seem to relate uniquely to chronic lymphatic edema, including a profound stimulus to collagen and adipose deposition. ² Experimental interstitial fluid stasis in murine models of acquired lymphedema has been utilized to effectively demonstrate the pathological attributes of human lymphedema, namely, inflammation, fat deposition, and fibrosis, ³ all a consequence of the initial impairment in circulatory function.

In the current issue of Lymphatic Research and Biology, Devoogt et al. ⁴ have explored in greater detail the phenomenon of cutaneous thickening that is a near-universal phenomenon in the natural history of acquired lymphedema. Utilizing an ultrasonographic approach, they determined thickness and echogenicity of cutis and subcutis in 42 subjects during the 12 months following an index surgical intervention. Sensitivity and specificity of the ultrasonographic technique was demonstrably high for detection of cuticular thickening, while disturbances of the subcutis, as defined by the imaging study, was less common.

This is pioneering work, insofar as in vivo assessment of cutaneous thickening has not, until now, been emphasized in the clinical evaluation and stratification of patients with acquired lymphedema. This approach is attractive: not only does it add another, imaging, dimension to the challenge of accurate lymphedema detection, but it very elegantly addresses, in a clinical context, one of the unique features of lymphedema natural history.^1–3 It is hoped that we can look forward to further refinement and definition of this approach in the future.