Cheng's grading system of lymphedema and available options for management

Grade	Symptoms	Circumference differentiation (%)	Lymphoscintigraphy	Management
0	Reversible	<9	Partial obstruction	CDT
I	Mild	10 to 19	Partial obstruction	CDT, LVA, liposuction
II	Moderate	20 to 29	Total obstruction	VLN transfer, LVA
III	Severe	30 to 39	Total obstruction	VLN transfer with liposuction or partial excision
IV	Very severe	>40	Total obstruction	Excision surgery with VLN transfer

CDT: complete decongestive therapy; LVA: lymphovenous anastomosis; VLN: vascularized lymph node.

Reprinted by permission from: Springer: Annals of Surgical Oncology. Patel KM, Lin CY, Cheng MH. A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Ann Surg Oncol 2015; 22:2424. Copyright © 2015. https://link.springer.com/journal/10434.

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Cheng's grading system of lymphedema and available options for management