Lymphoedema is a life-long condition and the rehabilitative therapeutic model of holistic approach has to include the self-management considering that it is designed to achieve not only short-medium term results, but also in the long term.
Self-management is achieved through therapeutic education (understanding of cause-evolution-cure of lymphoedema), which requires patient's adherence, and caregiver if necessary, which is reachable through an optimal communication (demonstration of empathy-ability to listen and understand discomfort-use of simple language), the evaluation of the characteristics of the patient /caregiver (age, psychological condition, cultural condition) and the respect  for their latency time (understand a concept-be aware of it-put it into practice).
Therapeutic education includes information on hygienic-behavioral rules, self-assessment of oedema, skin care, body weight control, physical activity, combined self-management (manual self-drainage, self-bandage), management of the elastic brace.
With regards to the self-efficacy tool for children the visual art methodology  is useful for the description of living and self-managing, while for teenagers the use of cameras to take photos is more useful.
Parents experienced difficulty before receiving a diagnosis and an appropriate treatment and younger children found self-management boring and restrictive and felt negative about the limitations imposed by their parents due to the fear of worsening of lymphoedema.

The diagnosis of Lipedema is based on clinical evaluation, but the high-resolution, non-invasive, repeatable and reliable ultrasound instrumental examination, relatively simple, even if operator dependent, is useful in the supra-fascial tissue study, using high-tech equipment with suitable high frequency linear probe.
Aim of the work
An evolution of standard ultrasound is high-quality three-dimensional imaging which, having a view on three planes of space, is interesting in the tissue structural study also for the possible processing of the image with appropriate software. For this reason, we have decided to apply this method in the tissue evaluation of lipedema.
Material and methods
In clinical stage I-II-III lipedema, with adequate the probe (17 MHz) placed directly on the skin,  and longitudinal-transversal scans on constant markers along the limbs,

Lymphoedema is a chronic disease with an evolutionary course without a suitable management. For this reason we have decided to analyze the coexistence of lymphoedema with Covid-19 pandemic.
During the 2020 lockdown there was the complete suspension of the rehabilitative treatment, public and private, and therefore the patients did not have a response to their disease.
In our centre, only the lymphologist examined patients with urgent clinical needs, after a triage call, but the team was always available to provide advice through phone-video calls.
In the post-lockdown, according to the intermittent government restrictions, we started again the rehabilitative treatments (environmental-personal hygiene rules, protective devices, U.V. air filtration, phone triage).
For patients in follow-up, in this Covid-19 pandemic, the vademecum has always talked about self-management that we have always included in the rehabilitative project as a therapeutic education (self-assessment of oedema, skin care, breathing exercises, manual self-drainage, home pressotherapy, self-bandaging, management of the elastic brace, respect of behavioural-rules, correct diet, physical activity).
In the first phase, clinical worsening in patients (26%), was due to  psychological distress, family problems and economic concerns that induced less-non attention to self-management previously learned.
Psychological distress for the fear of contagion, still leads some patients to postpone rehabilitative treatment.
During the lockdown there was the suspension of the rehabilitative treatment, but urgent clinical evaluation and phone-video calls really limited the clinical worsening. Following this, we are carrying out the rehabilitative treatment in environmental, team and patient safety.

La diagnosi di lipedema è basata sulla valutazione clinica, ma l’esame strumentale ecografico ad alta risoluzione, non invasivo, ripetibile ed affidabile, relativamente semplice, anche se operatore dipendente, risulta utile nello studio tissutale sopra-fasciale utilizzando apparecchiature ad alta tecnologia con sonde adeguate lineari ad alta frequenza di emissione del fascio ultrasonoro (>10 MHz).
Nel lipedema, con la sonda posta direttamente sulla cute con abbondante gel e utilizzando scansioni longitudinali e trasversali su punti markers costanti, lo studio ecografico tissutale comprende il complesso epidermide-derma ed il tessuto sottocutaneo.
In questo studio si è osservato una normale rappresentazione ecografica del complesso epidermide-derma (normale ecogenicità e spessore) ed un aumento dello spessore del tessuto sottocutaneo per ipertrofia dei lobuli adiposi adesi ed ipoecogeni,

M.CESTARI   CENTRO STUDI PIANETA LINFEDEMA - TERNI                                    

 Nel III stadio tardivo si sviluppa il lipo-linfedema evidenziato anche dall’esame  linfoscintigrafico che evidenzia un rallentato flusso del radiotracciante e comparsa del dermal back-flow, in presenza di normalità linfonodale regionale.
La diagnosi è clinica, ma troppo spesso tardiva e spesso il lipedema è confuso con altre patologie come:
-il linfedema, primario o secondario, che interessa entrambi i sessi, unilaterale o bilaterale asimmetrico (dipende dalla causa), con pitting presente prima della progressione ed insorgenza di fibrosi tissutale, e con usuale presenza del segno di Stemmer;