Physical therapy with good compliance remains the key of success in lymphedema management. Tissue excisions should be reserved for physiotherapy-resistant cases and always followed by extended maintenance compression therapy. We present the case of the successful physical therapy of the young female with a neglected, massive, primary lymphedema of the lower extremity present since birth, with prior extensive tissue resection. Complex decongestive physical therapy has been performed for one year, combined with ten months’ of negative-pressure wound therapy at a hospice facility due to pressure ulcers complication. Obtained reduction of the affected extremity/edema volumes (by 69.4 and 88.2% respectively) enhanced patient’s mobility, helping her become more independent. Ongoing therapeutical program maintained these results for three years. Physical therapy even in far-advanced and neglected cases may be effective. Lymphedema services should be offered widely through a network of fully reimbursed health care system, delivering high-quality evidence-based management tailored to individual patients.