Swelling
The entire arm or leg or part of it swells; clothes, shoes, or a watch become tight. At first, the swelling may come and go.
CONDITION / ARMS AND LEGS
Post-traumatic lymphedema.
Post-traumatic lymphedema is a persistent swelling of the arm or leg that appears when an injury damages the lymphatic pathways. It cannot be cured completely and permanently, but the swelling can be managed: first come compression and lymphatic drainage, and when they are insufficient, microsurgery of the lymphatic vessels is indicated.
CONCEPTUAL VISUALIZATION- What it is
- Swelling of the arm or leg because after an injury lymph does not drain well from the limb.
- How common
- In a study of 94 patients with open leg fractures and severe soft tissue damage, signs of lymphedema were found in 55%.
- Basis of treatment
- According to guidelines — anti-edema therapy: compression, lymphatic drainage, exercises, and skin care.
- Operations
- If this is not enough — microsurgery: lymphatic vessels are connected to veins.
01 / WHAT IS ITWhy a limb swells
Why a limb swells
after an injury.
The lymphatic system is a network of thin vessels and nodes that remove excess fluid from tissues and help fight infection. When an injury, surgery, or infection damages these vessels, fluid accumulates, and the limb swells. This is how secondary lymphedema develops: it can be caused by trauma, infection, inflammation of the limb, or lack of movement.
Lymphedema is a long-term condition. At first, the swelling is soft, leaves a pit when pressed, is greater in the evening, and decreases overnight. Without treatment, the swelling usually becomes firmer and more persistent, so it is important to notice it and start treatment as early as possible.
Doctors often do not recognize post-traumatic lymphedema. A review of studies on it found mostly case reports and small series, so there is less data than on lymphedema after cancer treatment. However, according to guideline reviews, the cause of lymphedema has little effect on treatment recommendations.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
Lymphedema presents.
The signs develop gradually, over weeks and months after the injury. The most important of them is swelling that does not go away.
Heaviness and pain
The limb aches, feels heavy, and it is harder to move it.
Skin changes
The skin becomes firm, stretched, and thicker, folds appear, sometimes growths resembling warts, or fluid seeps through the skin.
Recurrent infections
In a study of 420 patients with limb lymphedema, cellulitis (bacterial skin infection) was present in 12.6%, and in 56.6% of them it recurred.
Scars and contractures
After an injury, lymphedema can be combined with scars that tighten the skin and hinder movement.
Cicatricial deformation of the bodymood
A prolonged condition that changes appearance can be depressing; this should be mentioned to a doctor.
03 / REASONSWhat injuries
What injuries
lead to lymphedema.
Lymphedema appears where the injury has destroyed the lymphatic vessels in the skin and subcutaneous tissue.
Severe limb injuries
In the review of studies on lymphedema after injury, burns were most often described (12 out of 19 records), car accidents (7), skin avulsions—degloving (6), and open tibial fractures (4).
Open fractures
In a study of 94 patients with open leg fractures and soft tissue damage, signs of lymphedema were present in 55%, and 14% reported recurrent skin infections.
Which increases the risk
In the same study on lymphedema, obesity, the number of surgeries, infections, and compartment syndrome — a dangerous increase in pressure in the limb muscles — were associated.
Infection and immobility
Cellulitis sometimes itself causes lymphedema, and the lack of movement in the limb worsens fluid outflow.
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
Long-standing persistent swelling is a planned situation and usually does not require urgent care. But a limb with lymphedema is more prone to infection, and sudden swelling of one leg or arm may be a venous thrombosis.
103 immediately if:
- sudden shortness of breath;
- chest pain;
- purple spots appear on a red, swollen limb;
- during redness of the limb, a very high fever, the person alternates between feeling hot and cold or shivering;
- very frequent heartbeat or breathing;
- confusion or disorientation;
- skin is cold, sticky, or pale;
- person has fainted or is unresponsive.
Other levels of urgency:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: After surgery on a limb, the pain or swelling increases instead of decreasing. On the same day: The skin on the limb has turned red, hurts, is hot, and the swelling has increased — this happens with cellulitis, and early antibiotics prevent it from developing; one leg or arm suddenly hurts with pulsating pain and is swollen — possible venous thrombosis. In the coming days: If there is no improvement on antibiotics after 2–3 days — see the doctor again. Planned: Swelling that does not go away for weeks, heaviness, skin hardening — see a doctor: it is better to start treating lymphedema as early as possible.
05 / DIAGNOSTICSHow we make the
How we make the
diagnosis
- Questioning
What was the injury, what surgeries and infections occurred, when did the swelling appear, and does skin inflammation occur.
- Overview and measurements
The doctor examines the limb and measures its circumference. According to most guidelines, a volume difference of more than 10% compared with the other limb confirms lymphedema.
- Other causes of swelling
The doctor rules out other causes, including vein thrombosis, and evaluates blood circulation: compression is not suitable for everyone, for example, in cases of arterial problems in the legs.
- Lymphography
Before microsurgery, lymph outflow is assessed using special imaging — MR lymphangiography or lymphography with a fluorescent dye (ICG) — to identify functional lymphatic vessels.
- Skin and scars
The surgeon evaluates scars, tissue defects, and the condition of the skin — this determines what kind of surgery can be offered.
06 / TREATMENTHow we treat
How we treat
Lymphedema.
Lymphedema cannot be completely cured, but symptoms can usually be controlled. Treatment begins without surgery; microsurgery is considered when anti-swelling therapy does not give sufficient results. The International Society of Lymphology recognizes that no treatment method has yet undergone a proper meta-analysis.
01
Anti-swelling therapy
The basis of treatment according to guidelines.
- Intensive phase
- Several weeks of daily procedures: compression bandages, manual lymphatic drainage, exercises, and skin care to reduce limb volume.
- Maintenance phase
- Afterwards, the person wears compression garments themselves, performs self-massage, exercises, and cares for the skin; check-ups every few months.
- Lymphatic drainage
- Gentle manual technique that directs lymph to the working nodes. According to a systematic review of 17 studies, the results are contradictory: in mild lymphedema, it may additionally reduce volume, while in moderate and severe cases, it may not add benefit to the rest of the therapy. All these studies are about lymphedema after breast cancer.
- Exercises
- Limb muscles help lymph to move. In a review of 12 studies (367 participants) with leg lymphedema, exercises seem to have a small positive effect on quality of life, mobility, pain, and volume, but the quality of the studies is low.
02
Microsurgery
When conservative treatment does not help.
- Lymphovenous anastomoses
- Small lymphatic vessels are connected to veins under a microscope so that the lymph has a bypass route. According to the consensus of the American Society of Plastic Surgeons, there is evidence that this can reduce the severity of lymphedema; according to a review of systematic reviews for guidelines on leg lymphedema, the evidence supports the method when functional lymphatic vessels are found.
- Lymph node transplantation
- An area with lymph nodes on its own vessels is transplanted into the limb. It can provide more benefit at later stages, but there are more complications after it than after anastomoses.
- After an injury
- In a systematic review of 112 patients with post-traumatic lymphedema who underwent microsurgical operations, all studies described improvement, but comparative studies are lacking.
- What the numbers say
- According to a review of 26 systematic reviews, after microsurgery, the volume or circumference of the leg decreased by 34.16–46.8%, but the quality of these data is low; deaths and severe complications were not reported.
03
Other methods
- Liposuction
- In long-standing lymphedema, fat accumulates in the limb. It is removed by liposuction, after which compression garments must be worn continuously.
- Scars and defects
- If there is a lack of skin after an injury or thick scars, they are replaced with a flap; some surgeons take the flap along with lymphatic vessels.
04
Cellulitis
- Treatment
- Cellulitis is treated with oral antibiotics, severe cases in the hospital with intravenous antibiotics. Compression stockings are not worn until it gets better.
- Prevention
- Skin care reduces the risk of infection. If cellulitis recurs, the doctor may prescribe a long course of antibiotics in small doses.
- Surgery and infections
- According to a meta-analysis of 23 studies (648 limbs, observation over 2 years), after lymphovenous anastomoses and lymph node transplantation, skin inflammations decreased; almost all participants in these studies were women.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Post-traumatic lymphedema at the Dr. Valikhnovskyi Institute of Surgery is treated under the 'New Body' program, particularly as part of comprehensive recovery after injuries. First — compression and lymphatic drainage; lymphovenous anastomoses — when indicated. Cellulite and thrombosis are treated by the relevant specialist, the clinic is responsible for its part of the treatment.
CLINIC SERVICE
New body
Restoration of several areas of the body as a single sequence of stages — after injuries, major burns, or necroses.
View service
What we do for this condition
- Compression — compression garments; for lymphedema — often for a long time or continuously.
- Lymphatic drainage — manual techniques that aid fluid drainage; together with compression — the first step in treatment.
- Lymphovenous anastomoses — lymphatic vessels about 0.3–0.8 mm in diameter are sutured to small veins under a microscope.
- Scars and defects — excision of scars and reconstruction with local tissues, lipotransfer, free flaps.
- Rehabilitation — therapeutic exercise between stages — part of the treatment, not an addition.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of the limb, discharge summaries after the injury and surgeries — the doctor will preliminarily assess the situation.
- ConsultationExamination and measurements of the limb, assessment of scars and skin; list of examinations, in particular to exclude thrombosis.
- PlanFirst, compression and lymphatic drainage; if there are not enough of them, an examination of the lymphatic vessels and a decision on surgery.
- TreatmentDecongestant therapy, according to indications — lymphovenous anastomoses, scars and defects — in separate stages.
- RecoveryCompression garments, exercises and skin care; control of the volume of the limb.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Will the swelling go away on its own?
Lymphedema is a long-term condition, and without treatment, the swelling usually becomes firmer and more persistent. Therefore, it is better to show it to a doctor as early as possible.
Can lymphedema be cured with surgery?
Ultimately — no: no method, including surgery, cures lymphedema. Research shows that lymphovenous anastomoses can reduce the severity of lymphedema and help decrease limb size in some people. After surgery, compression garments usually still need to be worn, often continuously. Whether surgery is suitable, a surgeon will say after examining and performing tests on the lymphatic vessels.
Will lymphatic drainage help?
It is used as part of anti-edema therapy along with compression, exercises, and skin care. Separately from the rest of the therapy, research results are contradictory.
How long should compression garments be worn?
After the intensive phase, garments are worn during the maintenance phase so that swelling does not return; with lymphedema — often for a long time or continuously. With cellulite, compression stockings are not worn until it improves.
Is it possible to play sports?
Movement helps lymph flow; the exercise plan is made according to your limb and capabilities. Doctors often recommend swimming, cycling, and walking, as well as raising the limb whenever possible.
The leg has turned red and feels hot. What should I do?
If the skin is red, painful, hot, and swollen — see a doctor the same day. If very high fever, chills, purple spots, rapid heartbeat, or confusion are added — call 103.
Why is lymphedema dangerous?
The most common complication is cellulitis: fluid in the tissues makes the limb more susceptible to infection. A prolonged condition can also affect mood — this should be mentioned to the doctor.
Sources
18 sources · guidelines, consensuses, systematic reviews, cohorts and the NHSshowCollapse
- The Diagnosis and Treatment of Peripheral Lymphedema: 2023 Consensus Document of The International Society of LymphologyLymphology, 2023pubmed.ncbi.nlm.nih.gov/39207406 ↗
- Guidelines Relevant to Diagnosis, Assessment, and Management of Lymphedema: A Systematic ReviewAdvances in Wound Care, 2023doi:10.1089/wound.2021.0149 ↗
- Surgical Treatment of Lymphedema: A Systematic Review and Meta-Analysis of Controlled Trials. Results of a Consensus ConferencePlastic and Reconstructive Surgery, 2021doi:10.1097/PRS.0000000000007783 ↗
- Barcelona Consensus Paper on Reconstructive Lymphedema Surgery: A Delphi StudyPlastic and Reconstructive Surgery, 2026doi:10.1097/PRS.0000000000012201 ↗
- Microsurgical treatment of lower extremity lymphedema: An umbrella systematic review supporting the American Venous Forum and the American Vein and Lymphatic Society clinical practice guidelines on management of lymphedemaJournal of Vascular Surgery: Venous and Lymphatic Disorders, 2026doi:10.1016/j.jvsv.2026.102520 ↗
- A scoping literature review of post-traumatic lymphedema: Where are we now?Journal of Plastic, Reconstructive & Aesthetic Surgery, 2022doi:10.1016/j.bjps.2022.02.059 ↗
- Techniques and Outcomes in Microsurgical Treatment of Posttraumatic Lymphedema: A Systematic ReviewJournal of Reconstructive Microsurgery, 2024doi:10.1055/a-2257-5345 ↗
- Posttraumatic Lymphedema after Open Fractures of the Lower Extremity — A Retrospective Cohort AnalysisJournal of Personalized Medicine, 2021doi:10.3390/jpm11111077 ↗
- A Comprehensive Approach to Posttraumatic Lymphedema Surgical TreatmentArchives of Plastic Surgery, 2023doi:10.1055/s-0043-1768645 ↗
- Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic ReviewIndian Journal of Plastic Surgery, 2020doi:10.1055/s-0040-1709372 ↗
- Manual lymphatic drainage treatment for lymphedema: a systematic review of the literatureJournal of Cancer Survivorship, 2021doi:10.1007/s11764-020-00928-1 ↗
- Clinical features, microbiological epidemiology and recommendations for management of cellulitis in extremity lymphedemaJournal of Surgical Oncology, 2020doi:10.1002/jso.25525 ↗
- The effect of exercise in patients with lower limb lymphedema: a systematic reviewActa Oncologica, 2025doi:10.2340/1651-226X.2025.42560 ↗
- Lymphovenous Anastomosis and Vascularized Lymph Node Transfer Reduce Long-term Cellulitis Events in Patients With Secondary Lymphedema: A Systematic Review and Meta-analysisAnnals of Plastic Surgery, 2025doi:10.1097/SAP.0000000000004508 ↗
- LymphoedemaNHS, 2023nhs.uk/conditions/lymphoedema ↗
- Lymphoedema: treatmentNHS, 2023nhs.uk/conditions/lymphoedema/treatment ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
- DVT (deep vein thrombosis)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
The figures on the page are from these sources.
Swelling after injury
does not pass?
Send a photo of the limb and discharge after injury and surgery. The doctor will tell you where to start and whether surgery is needed.