A 48-year-old woman presents with progressive, painless swelling of the right leg over 8 months following radical hysterectomy and pelvic radiotherapy for cervical cancer. Examination reveals non-pitting edema with peau d'orange skin changes. Lymphoscintigraphy shows dermal backflow with absent lymphatic drainage. Which is the first-line management?

• A Diethylcarbamazine therapy
• B Complete decongestive therapy with compression garments ✓
• C Surgical lymphovenous anastomosis
• D Excisional surgery with skin grafting (Charles procedure)

Explanation

This is secondary lymphedema post-radical surgery and radiotherapy. Complete decongestive therapy (CDT) with manual lymphatic drainage and graduated compression garments is first-line. Diethylcarbamazine treats filarial lymphedema, which is endemic in India but this patient has a clear postsurgical cause. Surgical options (lymphovenous anastomosis or excisional procedures) are reserved for refractory cases failing conservative management for at least 6-12 months.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.