● We evaluating Role of pre–operative and post–operative pneumatic compression and other physiotherapy exercises in management and rehabilitation in patients with lymphedema. Implementation Of reconstructional procedures (neibulowitz Nodo–venous shunt and lymphatico–venous shunt) alone and in conjunction with definitive excisional procedure according to the grade and type of Lymphedema. ● The results were that Patients with low grade lymphedema and chylous ascites were managed solely on reconstructional procedures alone with proper physiotherapy and dietary modification expending the need for excisional procedures. Performing a reconstructional procedure before excisional procedure for high grade lymphedema and tailoring the time frame between the two , can significantly decrease perioperative morbidity in terms of operative time, need for blood transfusion and ease of resection. Post operative course in terms of less Lymphorrhea , less chances of graft failure and better rehabilitation