Superficial and Functional Lymphatic Anatomy of the Upper Extremity.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 10 2022
01 10 2022
Historique:
pubmed:
9
8
2022
medline:
1
10
2022
entrez:
8
8
2022
Statut:
ppublish
Résumé
Knowledge of detailed lymphatic anatomy in humans is limited, as the small size of lymphatic channels makes it difficult to image. Most current knowledge of the superficial lymphatic system has been obtained from cadaveric dissections. Indocyanine green lymphography was performed preoperatively to map the functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, indocyanine green imaging, and surgical data. Three main functional forearm channels with variable connections to two upper arm pathways were identified. The median forearm channel predominantly courses in the volar forearm (99 percent). The ulnar forearm channel courses in the volar forearm in the majority of patients (66 percent). The radial forearm channel courses in the dorsal forearm in the majority of patients (92 percent). Median (100 percent), radial (91 percent), and ulnar (96 percent) channels almost universally connect to the medial upper arm channel. In contrast, connections to the lateral upper arm channel occur less frequently from the radial (40 percent) and ulnar (31 percent) channels. This study details the anatomy of three forearm lymphatic channels and their connections to the upper arm in living adults without lymphatic disease. Knowledge of these pathways and variations is relevant to any individual performing procedures on the upper extremities, as injury to the superficial lymphatic system can predispose patients to the development of lymphedema.
Sections du résumé
BACKGROUND
Knowledge of detailed lymphatic anatomy in humans is limited, as the small size of lymphatic channels makes it difficult to image. Most current knowledge of the superficial lymphatic system has been obtained from cadaveric dissections.
METHODS
Indocyanine green lymphography was performed preoperatively to map the functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, indocyanine green imaging, and surgical data.
RESULTS
Three main functional forearm channels with variable connections to two upper arm pathways were identified. The median forearm channel predominantly courses in the volar forearm (99 percent). The ulnar forearm channel courses in the volar forearm in the majority of patients (66 percent). The radial forearm channel courses in the dorsal forearm in the majority of patients (92 percent). Median (100 percent), radial (91 percent), and ulnar (96 percent) channels almost universally connect to the medial upper arm channel. In contrast, connections to the lateral upper arm channel occur less frequently from the radial (40 percent) and ulnar (31 percent) channels.
CONCLUSIONS
This study details the anatomy of three forearm lymphatic channels and their connections to the upper arm in living adults without lymphatic disease. Knowledge of these pathways and variations is relevant to any individual performing procedures on the upper extremities, as injury to the superficial lymphatic system can predispose patients to the development of lymphedema.
Identifiants
pubmed: 35939638
doi: 10.1097/PRS.0000000000009555
pii: 00006534-202210000-00034
pmc: PMC9674086
mid: NIHMS1850394
doi:
Substances chimiques
Coloring Agents
0
Indocyanine Green
IX6J1063HV
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
900-907Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL157991
Pays : United States
Informations de copyright
Copyright © 2022 by the American Society of Plastic Surgeons.
Références
Suami H, Koelmeyer L, Mackie H, Boyages J. Patterns of lymphatic drainage after axillary node dissection impact arm lymphoedema severity: A review of animal and clinical imaging studies. Surg Oncol. 2018;27:743–750.
O’Brien BM, Das SK, Franklin JD, Morrison WA. Effect of lymphangiography on lymphedema. Plast Reconstr Surg. 1981;68:922–926.
Bron KM, Baum S, Abrams HL. Oil embolism in lymphangiography: Incidence, manifestations, and mechanism. Radiology 1963;80:194–202.
Suami H, Taylor GI, Pan WR. The lymphatic territories of the upper limb: Anatomical study and clinical implications. Plast Reconstr Surg. 2007;119:1813–1822.
Turfe Z, Pettinga J, Leduc O, Leduc A, Komorowska-Timek E. Chemotherapy port related lymphedema after axillary lymph node dissection. Breast 2016;28:145–147.
Mascagni P. Vasorum lymphaticorum corporis humani. In: Historia & Iconographia. Senis (Siena): Pazzini Carli; 1787.
Sappey P. Anatomie, physiologie, pathologie des vesseaux lymphatiques consideres chez l’homme et les vertebres. Available at: http://ci.nii.ac.jp/naid/10012361149/ . Accessed July 10, 2020.
Leduc A, Caplan I, Leduc O. Lymphatic drainage of the upper limb: Substitution lymphatic pathways. Eur J Lymphol Relat Probl. 1993;4:11–18.
Suami H, Scaglioni MF. Anatomy of the lymphatic system and the lymphosome concept with reference to lymphedema. Semin Plast Surg. 2018;32:5–11.
Granoff MD, Johnson AR, Lee BT, Padera TP, Bouta EM, Singhal D. A novel approach to quantifying lymphatic contractility during indocyanine green lymphangiography. Plast Reconstr Surg. 2019;144:1197–1201.
Johnson AR, Fleishman A, Tran BNN, et al. Developing a lymphatic surgery program: A first-year review. Plast Reconstr Surg. 2019;144:975e–985e.
Pan WR, Zeng FQ, Wang DG, Qiu ZQ. Perforating and deep lymphatic vessels in the knee region: An anatomical study and clinical implications. ANZ J Surg. 2017;87:404–410.
Johnson AR, Bravo MG, James TA, Suami H, Lee BT, Singhal D. The all but forgotten Mascagni-Sappey pathway: Learning from immediate lymphatic reconstruction. J Reconstr Microsurg. 2020;36:28–31.
Pissas A, Rzal K, Math ML, el Nasser M, Dubois JB. Prevention of secondary lymphedema. Ann Ital Chir. 2002;73:489–492.
Kim G, Smith MP, Donohoe KJ, Johnson AR, Singhal D, Tsai LL. MRI staging of upper extremity secondary lymphedema: Correlation with clinical measurements. Eur Radiol. 2020;30:4686–4694.
Boneti C, Korourian S, Bland K, et al. Axillary reverse mapping: Mapping and preserving arm lymphatics may be important in preventing lymphedema during sentinel lymph node biopsy. J Am Coll Surg. 2008;206:1038–1042; discussion 1042–1044.
Singhal D, Tran BN, Angelo JP, Lee BT, Lin SJ. Technological advances in lymphatic surgery: Bringing to light the invisible. Plast Reconstr Surg. 2019;143:283–293.