Primary
lymphedema can be managed effectively as a form of chronic
lymphedema by a sequenced and targeted treatment and management program based around a combination of Decongestive Lymphatic
Therapy (DLT) with compression
therapy, when the latter is desired as an adjunct to DLT. Treatment in the maintenance phase should include compression garments, self-management, including self-
massage, meticulous personal hygiene and
skin care, in addition to lymphtransport-promoting excercises and activities, and, if desired, pneumatic compression
therapy applied in the home. When
conservative treatment fails, or gives sub-optimal outcomes, the management of primary
lymphedema can be improved, where appropriate, with the proper addition of surgical interventions, either reconstructive or ablative. These two surgical
therapies can be more effective when fully integrated with
manual lymphatic drainage (MLD)-based DLT postoperatively. Compliance with a long-term commitment to MLD/DLT and particularly compression postoperatively is a critical factor in determining the success of any new treatment strategy involving either reconstructive or
palliative surgery. The future of management of primary
lymphedema has never been brighter with the new prospect of gene-and perhaps stem-cell oriented management.