Anatomy of the superficial lymphatics of the abdominal wall and the upper thigh and its implications in lymphatic microsurgery

Summary Background The recent advent in the surgical treatment of lymphedema necessitates a more detailed understanding of the anatomy of the lymphatic system. Lymphovenous anastomosis (LVA) requires a precise knowledge of the anatomy of the superficial lymphatic collectors in relation to the superf...

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Bibliographic Details
Published in:Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2013-10, Vol.66 (10), p.1390-1395
Main Authors: Tourani, Saam S, Taylor, G. Ian, Ashton, Mark W
Format: Article
Language:English
Subjects:
(Supra) Microsurgery
Abdominal Wall - anatomy & histology
Abdominal Wall - blood supply
Abdominal Wall - surgery
Anastomosis, Surgical
Cadaver
Female
Humans
Lymph Nodes - transplantation
Lymphatic anatomy
Lymphatic Vessels - anatomy & histology
Lymphedema
Lymphedema - surgery
Lymphovenous anastomosis
Male
Microsurgery
Plastic Surgery
Surgical Flaps - blood supply
Thigh - anatomy & histology
Thigh - blood supply
Thigh - surgery
Vascularised lymph node transfer
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Summary:Summary Background The recent advent in the surgical treatment of lymphedema necessitates a more detailed understanding of the anatomy of the lymphatic system. Lymphovenous anastomosis (LVA) requires a precise knowledge of the anatomy of the superficial lymphatic collectors in relation to the superficial veins. In vascularized lymph node transfer (VLNT), donor site lymphatic function must be preserved. Methods Using the previously described technique, the superficial lymphatic drainage of 8 anterior hemi-abdomen/upper thigh specimens from 4 fresh human cadavers was investigated. Results The upper and lower abdominal collectors were found above Scarpa's fascia immediately below the subdermal venules. They were thin-walled and translucent and their diameter ranged between 0.2 and 0.8 mm. In the upper thigh two distinct groups of superficial collectors were found. The collectors of the ventromedial bundle constituted the majority of the superficial collectors, were deep in the subcutaneous fat, measured 0.6–1 mm in diameter, had thick walls, and consistently drained into two large nodes inferolateral to the saphenous bulb. The local collectors of the thigh were immediately deep to the subdermal venules, measured 0.3–0.5 mm, had thin walls, and drained into the superolateral group of the superficial inguinal nodes which also drained the lower abdomen, the lower back and the upper gluteal region. Conclusions When raising the groin lymphatic flap for VLNT, the medial extent of the dissection should be limited to the lateral border of femoral artery. When following up patients after VLNT with a groin donor site, circumference measurements must include the upper thigh.
ISSN:1748-6815
1878-0539
DOI:10.1016/j.bjps.2013.05.030