Lympheodema is the interruption of lymphatic drainage from a region of the body, resulting in accumulation of lymph fluid in that region. Lymphoedema may result from an expanding range defects in genes that are recognized to guide normal development of the lymphatic system. In addition, insults acquired after normal development, such as surgery or radiotherapy for cancer treatment, may result in so-called 'Secondary Lymphoedema'.

The consequences for patients suffering Lymphoedema are progressive and incurable swelling, pain, stiffness, musculoskeletal and other functional impairment and recurrent infection. 

Traditionally, specialized garments and physical therapy have formed the mainstays of life-long treatment. More recently surgical treatments such as lymph node transfer, lymphaticovenous anastamosis and liposuction have emerged as promising potential avenues for ameliorating symptoms for lymphoedema patients, as have novel molecular therapies. Here we discuss an image-based algorithm developed for patient assessment and selection for surgical treatment according to MR lymphangiographic assessment. A new paradigm is presented for managing patients in an Australian setting, and the results for lymphaticovenous anastomosis and other surgery, as analysed using independently-assessed measures of upper and lower limb primary and secondary Lymphoedema.