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Open Access
CC BY 4.0 · J Reconstr Microsurg
DOI: 10.1055/a-2803-4526
Original Article

Screening for Posttraumatic Lower Extremity Lymphedema: Patient Characteristics, Risk Factors, and Quality of Life Outcomes

Authors

  • Chelsea A. Allen-Brough

    1   Department of Plastic and Reconstructive Surgery, Waikato Hospital, Hamilton, New Zealand

  • Brett A. Hahn 

    2   Department of Plastic and Reconstructive Surgery, Utrecht University Medical Center, Utrecht, The Netherlands

  • Patrick Romijn

    3   Department of Plastic and Reconstructive Surgery, Radboudumc, Nijmegen, The Netherlands

  • Stefan Hummelink 

    3   Department of Plastic and Reconstructive Surgery, Radboudumc, Nijmegen, The Netherlands

  • Arne C. Berger

    4   Department of Orthopedic Surgery, ETZ Hospital, Tilburg, The Netherlands

  • Pim van Egmond

    4   Department of Orthopedic Surgery, ETZ Hospital, Tilburg, The Netherlands

  • Dietmar J. O. Ulrich

    3   Department of Plastic and Reconstructive Surgery, Radboudumc, Nijmegen, The Netherlands

  • Tim de Jong

    1   Department of Plastic and Reconstructive Surgery, Waikato Hospital, Hamilton, New Zealand
    3   Department of Plastic and Reconstructive Surgery, Radboudumc, Nijmegen, The Netherlands
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Abstract

Background

Lower extremity lymphedema (LEL) is a frequent, under-recognized, and chronic condition. The prevalence of this condition in patients with lower limb trauma is unclear. A self-reported lower extremity lymphedema screening questionnaire (LELSQ) was recently validated for screening LEL. The primary aim of this study was to investigate the clinical and demographic characteristics of posttraumatic LEL (PTLEL) in patients with a history of severe lower extremity trauma using the LELSQ. Secondary objectives were to identify risk factors for PTLEL, to investigate the relationship between LELSQ scores, health-related quality of life (HR-QoL), and lower extremity functioning.

Methods

Patients treated for complex lower extremity trauma between January 1, 2009, and December 31, 2019, in two level one trauma centers who meet inclusion criteria were sent three questionnaires: LELSQ, Eq. 5D-5L, and the Lower Extremity Functional Scale (LEFS). Additionally, baseline demographic and trauma data were collected.

Results

A total of 115 patients (46.0%) responded, of which 95 were included. LELSQ screened 59 patients (62.1%) positive for PTLEL. Those with PTLEL reported more problems with daily life, with a lower median EQ-VAS and EQ-index score (70.0 and 0.700, respectively) compared with non-PTLEL (90.0 and 0.874, respectively). A clinically reported difference was found in the LEFS median scores, with PTLEL 39.0 compared with 66.0 in non-PTLEL.

Conclusion

Among patients who participated in this study, 62.1% screened positive for PTLEL following complex lower limb trauma. PTLEL patients reported reduced HR-QoL and lower extremity functioning compared with non-PTLEL patients, indicating that this is a frequent and important issue following lower limb trauma.

Keywords

lower extremity lymphedema - posttraumatic lower extremity lymphedema - LEFS - EQ-5D-5L - LELSQ

Ethical Approval

Ethical approval was obtained from the Radboudumc institutional review board under protocol 2019–5765. This paper was presented, in part, at the Joint Scientific Meeting of the New Zealand Association of Plastic Surgeons, August 29 to 30, 2024, Christchurch, New Zealand.


Informed Consent

Patients/guardians have given informed written consent to the publication of images and/or data.


Supplementary Material



Publication History

Received: 20 January 2025

Accepted: 27 July 2025

Accepted Manuscript online:
04 February 2026

Article published online:
20 February 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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