Anatomosurgical Implications Derived from an Embryological Study of the Scarpa's Triangle with Particular Reference to Groin Lymphadenectomy

Micheletti, Leonardo; Levi, A. C.; Bogliatto, Fabrizio

doi:10.1006/gyno.1998.5073

“…Regarding anatomical literature, the classic Italian, French, German, and English [7][8][9][10] textbooks have been reviewed. However, the major part of the macroscopic anatomical knowledge is nearly always copied from book to book without questioning and is rarely interpreted from a surgical point of view [4,11,12]. We are aware that, as part of the present study, the examination of some adult female cadavers would have add a further useful information, however, due to Italian recent legal restrictions, it has not been possible to perform any cadaveric anatomical dissection.…”

Section: Methodsmentioning

confidence: 91%

“…For this reason, the inguinofemoral lymphadenectomy remains a necessary component in the surgical management of invasive vulvar cancer and, ideally, should be performed removing all the lymph nodes-inguinal and femoral-while sparing normal tissues and structures. Regarding the depth of the surgical excision, embryological [12], anatomotopographical [11], and surgical [24] studies have clearly demonstrated that deep femoral lymphadenectomy can be performed without removing the femoral fascia. Actually, the deep femoral nodes are always situated within the opening of the fossa ovalis, medially to the femoral vein [7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Actually, the deep femoral nodes are always situated within the opening of the fossa ovalis, medially to the femoral vein [7][8][9][10][11]. There are no lymph nodes distal to the lower margin of the fossa ovalis and lateral to the femoral vessels, beneath the femoral fascia [11,12]. This disposition represents the result of the progression in the development of all structures of the Scarpa's triangle.…”

Section: Discussionmentioning

confidence: 99%

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Rationale and definition of the lateral extension of the inguinal lymphadenectomy for vulvar cancer derived from an embryological and anatomical study

Micheletti

¹

,

Levi

²

,

Bogliatto

³

et al. 2002

Journal of Surgical Oncology

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Background and Objectives The objective of the present study was to define the location of the most lateral superficial inguinal node lying along the inguinal ligament, through an embryological and anatomotopographical study, in order to rationalize the lateral extension of the groin lymphadenectomy in vulvar cancer. Methods Sections of the upper portion of the femoral triangle belonging to three human fetuses, whose crown‐rump (CR) length ranged from 70 to 310 mm, corresponding to a developmental age of 11 and 35 weeks, were studied. In addition, for an objective topographical evaluation of the disposition of the superficial inguinal lymph nodes, adult cadavers photographs of dissected Scarpa's triangle, reported in anatomical atlases, were analyzed. Results Both the embryological investigation and the anatomotopographical evaluation on cadavers photographs demonstrate that the most lateral superficial inguinal lymph node does not rise above the medial margin of the sartorius muscle, nor far lateral to the point where the superficial circumflex iliac vessels cross the inguinal ligament. Conclusions On the basis of the present study, the authors believe that the superficial circumflex iliac vessels could represent the lateral surgical landmark, easily detectable, at which the inguinal lymphadenectomy should cease. Therefore, there is no need to extend the lateral excision to the anterior superior iliac spine. Finally, leaving the fatty tissue laterally to these vessels, some lymphatic channels could be preserved, decreasing the incidence and the entity of wound seroma and lymphedema. J. Surg. Oncol. 2002;81:19–24. © 2002 Wiley‐Liss, Inc.

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“…However, the cribriform fascia, or lamina cribrosa (the term preferred by Micheletti et al . ( 10 ) is not only fenestrated, but also has a very indistinct distal border, as compared with the crescentic upper margin. Some of the proximal nodes of the vertical superficial inguinal chain might thus appear to be deep ‘femoral’ nodes.…”

Section: Present Studymentioning

confidence: 99%

The surgery of 'inguino-femoral' lymph nodes: is it adequate or excessive?

Hudson

¹

,

Shulver

²

,

Lowe

³

2004

Int J Gynecol Cancer

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In the management of women with any but the earliest vulval carcinoma, the received surgical dogma is that there should be complete removal of all potentially involved lymph nodes in the groin (distal to the inguinal ligament). Traditionally, this has included stripping bare the femoral vessels after unroofing the deep fascia in the proximal thigh (Hunter's canal), although currently a number of surgeons carrying out block dissection of the groin would be less radical. The morbidity of the more extensive block dissection is important, and the need for a procedure of this magnitude has been challenged on the basis that a deep node chain does not extend more distally than the sapheno-femoral junction. This study examined possible reasons for this important difference of opinion. In 20 targeted anatomical groin dissections from cadavers, no nodes were identified deep to the deep fascia distal to saphenous opening. However, in the cribriform fascia covering the saphenous opening, some nodes of the superficial group were found within fenestrations of this fascia, which might account for the historic descriptions of deep femoral nodes distal to the sapheno-femoral junction. This finding also suggested that an inguinal lymphadenectomy confined to the superficial fascia may fail to include all those nodes normally regarded as being in the superficial inguinal group. Together, these findings also lend support to the contention that neither the removal of deep fascia in the femoral triangle nor its incision, with consequent stripping of the femoral vessels in the thigh, is normally necessary in a radical groin node dissection.

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“…Other than documenting that there is a difference of opinion on the distribution of subfascial lymph nodes in the groin, no one has offered an explanation of why such a difference of opinion should have arisen other than a suggestion (1) that the more distal nodes might ordinarily be too small for macroscopic detection. However, the cribriform fascia, or lamina cribrosa (the term preferred by Micheletti et al (10) is not only fenestrated, but also has a very indistinct distal border, as compared with the crescentic upper margin. Some of the proximal nodes of the vertical superficial inguinal chain might thus appear to be deep 'femoral' nodes.…”

Section: Present Studymentioning

confidence: 99%

The surgery of ‘inguino-femoral’ lymph nodes: is it adequate or excessive?

Hudson

¹

,

Shulver

²

,

Lowe

³

2004

Int J Gynecol Cancer

View full text Add to dashboard Cite

In the management of women with any but the earliest vulval carcinoma, the received surgical dogma is that there should be complete removal of all potentially involved lymph nodes in the groin (distal to the inguinal ligament). Traditionally, this has included stripping bare the femoral vessels after unroofing the deep fascia in the proximal thigh (Hunter's canal), although currently a number of surgeons carrying out block dissection of the groin would be less radical. The morbidity of the more extensive block dissection is important, and the need for a procedure of this magnitude has been challenged on the basis that a deep node chain does not extend more distally than the sapheno-femoral junction. This study examined possible reasons for this important difference of opinion. In 20 targeted anatomical groin dissections from cadavers, no nodes were identified deep to the deep fascia distal to saphenous opening. However, in the cribriform fascia covering the saphenous opening, some nodes of the superficial group were found within fenestrations of this fascia, which might account for the historic descriptions of deep femoral nodes distal to the sapheno-femoral junction. This finding also suggested that an inguinal lymphadenectomy confined to the superficial fascia may fail to include all those nodes normally regarded as being in the superficial inguinal group. Together, these findings also lend support to the contention that neither the removal of deep fascia in the femoral triangle nor its incision, with consequent stripping of the femoral vessels in the thigh, is normally necessary in a radical groin node dissection.

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Anatomosurgical Implications Derived from an Embryological Study of the Scarpa's Triangle with Particular Reference to Groin Lymphadenectomy

Cited by 25 publications

References 6 publications

Rationale and definition of the lateral extension of the inguinal lymphadenectomy for vulvar cancer derived from an embryological and anatomical study

Rationale and definition of the lateral extension of the inguinal lymphadenectomy for vulvar cancer derived from an embryological and anatomical study

The surgery of 'inguino-femoral' lymph nodes: is it adequate or excessive?

The surgery of ‘inguino-femoral’ lymph nodes: is it adequate or excessive?

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