1st Stage: Diagnosis of Lymphedema
Patients will be diagnosed for lymphedema and the necessary accompanying tests will be performed. The diagnosis will be made either by the team of vascular surgeons or by the team of dermatologists, individually after an appointment at the outpatient clinics or at a day and time set by the team of doctors and during which all possible cases of lymphedema will be examined. Once the diagnosis is made, the patients are given an informative brochure with information about the condition and the methods of treatment and are referred for information and consultation to the physiotherapy department .

2nd Stage: Counseling – Informing patients about lymphedema
Patients are consulted and informed in the physical therapy department by the physical therapists participating in the program. It applies to all patients, whether they are going to participate in the program of multifactorial treatment of lymphedema, or whether they are going to take home instructions and be monitored for the progression of lymphedema at regular intervals. It is done by personal appointment at a time and day determined by the physical therapists in consultation with the patients. The basic instructions for dealing with lymphoedema are provided (verbally and with a detailed brochure) and advice is given on the necessary lifestyle changes (skin-nail care, daily exercise, elastic socks, weight loss, factors that have a negative effect on lymphoedema). Finally, there is an update on the multifactorial lymphedema treatment program (procedure, duration, cost). If the patient decides to participate, he returns at a predetermined day and time for the third stage of the program.

3rd Stage: Selection of patients for the multifactorial lymphedema management program.
The selection of patients who wish to participate, who are suitable and are going to benefit, but also cope with the multifactorial treatment program is done by the team of vascular surgeons, dermatologists and physical therapists. It takes place at a selected time and day, in which patients who want to participate are invited, examined by the team, in terms of the necessity of participation, the expected results, the possibility of participation (financial, time, daily transport to the hospital), the desire and the ability to follow and comply with program instructions, both during and after treatment.
Once the selection of patients considered suitable is made, the day of treatment initiation is set, based on the waiting list and the patient's capabilities, and the patient is informed about the stages of the program and the necessary preparation.  

4th Stage: Preparing Patients for the lymphedema treatment program.
Patient preparation includes the purchase of the necessary materials (bandages, skin protection and antifungal cream, as well as a larger than usual number of shoes). The selection of materials is made by the team's physiotherapists, in consultation with an external supplier. The purchase of bandages is done by the patient, but it is written in the booklet and the necessary certificate is provided for the condition and their necessity. The purchase of creams and shoes is also done by the patient. The patient is also advised to bring a sheet and towels.
During the preparation stage, the patient is advised to take care of the hygiene and condition of the nails (manicure – pedicure)

5th Stage: Appointment with the team of dermatologists.
The patient should be evaluated by the team of dermatologists for the condition of the skin of the member with lymphedema and any accompanying problems (fungi, erysipelas, wounds, skin lesions) treated. If deemed necessary due to skin problems, the start of the program can be postponed until they are successfully treated. A specific day and time has been set by the team of dermatologists during which they evaluate and advise the patients with lymphedema who are going to take part in the program. The visit takes place at the dermatology outpatient clinics and is scheduled every Wednesday 10:00 - 11:00. It is done by telephone appointment by the patient himsel .

6th Stage: Appointment with the Dietician. Start of Nutrition program.
If the patient does not have the ideal body weight, he must start a diet plan to lose the extra pounds. If he has the ideal body weight, he should be informed about the correct eating habits. The patient is given the option of being monitored by Dietician Stavroula Tsioli. The first appointment is determined by phone by the patient himself. In the first session, the patient is evaluated, the history is recorded and the personalized nutrition plan is created based on his needs. Also, the patient is consulted and informed about issues related to nutrition in relation to lymphedema .

7th Stage: Psychological Support of patients
In the context of the multifactorial treatment of lymphedema and since it is a chronic condition and often linked to the treatment of cancer, the patients are evaluated by the team's psychologist Ioanna Tsiouris and advice is provided on the best psychological treatment of their condition. There are 2 sessions for each patient participating in the program, the first before the start of the physical therapy program and the second after the end of the physical therapy program. In cases of patients deemed necessary, further treatment may be needed.

8th Stage: Start of Physiotherapy Program.
Physiotherapy is based on the principles of Complete Decongestive Therapy usually starts on Monday, provided that any skin problems have been previously treated and provided they have the necessary dressing materials are purchased. It takes place at the physical therapy center in a room designed for the needs of the program. In the room there are exercise equipment, treatment beds, intermittent compression pump, patient lift, patient photography area for the record.
.  
Physiotherapy is performed by physiotherapists members of the multifactorial group Stankova-Salta Rumiana and Papadopoulou Maria-Christina
In the first session, the circumference of the lymphedematous limb is measured and the limb is photographed for the record. Physiotherapy begins with a special bandaging of the limb with lymphedema with foam material and an elastic bandage to treat the fibrosis and a special drainage massage on the rest of the body. It continues with a decongestant massage on the lymphedematous member and application of moisturizing cream and anti-fungal cream. Then a special multi-layer bandaging takes place with elastic bandages of small stretch. Once the bandaging is complete, the patient, depending on his abilities and needs, starts exercising on a treadmill, stationary bike, stepper, elliptical exercise machine and an upper extremity exercise machine. During the exercise or treatment, the patient is informed about issues related to the treatment of lymphedema. Also, during the treatment, the patient or attendant is trained in bandaging and ways to treat lymphedema at home and after the end of the treatment. The same process is repeated every day from Monday to Friday. Each preparation is a measurement of the member's circumference and a record of the improvement.  
The duration of the program per day is from 1 to 2 hours for each patient and the total duration of the intensive program is 3 to 4 weeks of daily physical therapy excluding the weekend.
2 to 3 patients can be treated daily.

9th Stage: Informing patients
Patients during the program have 1-2 hours of information about the condition and ways to treat it. The information is given at the physical therapy center, by the physical therapist members of the team with the help of a computer, posters and samples of the available materials. Patients are informed about the lymphatic system, what lymphedema is, how it is created and treated, factors that benefit or negatively affect lymphedema. They are also informed about materials that exist on the market and that can be obtained and about alternative ways of exercising.

10th Stage: Completion of the program
Once the physical therapy program is successfully completed, patients are examined by the multifactorial team and lymphedema improvement is recorded. The girth is measured and the member is photographed for the record.
The patient then obtains an elastic sock or sleeve to order from the available brands on the market. It must be emphasized that it is necessary to travel to Thessaloniki or Athens in order to measure the member and order the sock exactly to the patient's dimensions. The patient must obtain a ready-made stocking or sleeve in standard dimensions until receiving the custom-made stocking (10 days). After purchasing the sock, the patient returns to the physical therapy clinic to be instructed on proper application, to assess its fit, and to make some additions to the dressing or compression material.
Afterwards, the patient is given the necessary instructions for home and a re-evaluation appointment is arranged at 1 month, 3 months, 6 months and 1 year. If deemed necessary, an appointment can be arranged to repeat the treatment.