Divergent Lymphatic Drainage Routes from the Heel to the Inguinal Region: Anatomic Study and Clinical Implications

Abstract

Two different lymphatic routes from the heel to the inguinal lymph nodes have been described. This information upgrades current anatomical knowledge and the results will be of benefit for the clinical management of lower limb trauma and malignancy.

Perforating and deep lymphatic vessels in the knee region: an anatomical study and clinical implications

“…We believe that the deep popliteal nodes in patterns 2 and 3 collected the isotope that passed via either the superficial route (the lymph vessel accompanying with the SSV) (Figs ,) or the deep route (connected by the perforating lymph vessel between the superficial and deep vessels in the posterior part of the leg) (Figs ,) . Furthermore, according to the results from this study and previous reports, the subsequent tier node would be located in the popliteal fossa (the deep popliteal node) or the groin (the inguinal node) in pattern 1 (Figs ,). In patterns 2 and 3, if there were multiple deep popliteal nodes the subsequent node would be found within the group (Fig.…”

“…Clinical management requires accurate and detailed anatomical understanding of the lymphatic pathways in the lower limb. The knowledge of the superficial lymphatic anatomy in the lower limb has been updated during the last decade . Although the deep lymphatic pathways of the lower limb had been mentioned and depicted in few literature but the relationship between the superficial and deep lymphatic vessels of the lower limb has not yet been clarified, the knowledge is unable to explain some of the unexpected findings seen clinically .…”

“…It was not realized until the mid 20th century that a lymph vessel, arising from the superficial popliteal lymph node, could drain into the deep popliteal lymph node from where the efferent vessel travelled with the femoral vascular bundle and then entered the inguinal lymph node . Recently, it was found that the lymph vessel arising from the deep popliteal lymph node could drain into the inguinal lymph node via the femoral route, the external iliac node via the profunda route by piercing the obturator foramen and the inferior gluteal node via the sciatic route . In this study, we have presented two sites of the perforating lymph vessel linking the superficial posterior group to the deep lymph vessel; one was in the popliteal fossa regularly and the other one in the distal third of the leg, which, unfortunately, could be an alternative pathway for metastases disease in the leg.…”

“…Clinical management requires accurate and detailed anatomical understanding of the lymphatic pathways in the lower limb. Although, the knowledge of the superficial lymphatic anatomy in the lower limb has been renewed during the last decade, further study should be carried on especially regarding the deep lymphatic pathways and the perforating lymph vessel to renew our knowledge of the human lymphatic system.…”

Intraoperatively Detected But Previously Indocyanine Green–Negative Lymphatic Vessels May Have Misprized Potentials and Should Not Be Neglected in Lymphaticovenous Bypass Surgery

“…In order to further assist in the clinical management of lower limb lymphatic disorders, cadaver studies have been implemented to prove that divergent and alternative lymphatic drainage pathways do exist. 4,5 Recently, a new concept of lymphosomes was introduced after studying the lymphatic system in different animals and human cadavers in order to establish a better understanding of the anatomy, which is paramount for current procedures in the surgical management of cancers and lymphedema. 6 Superficial lymphatic vessels diverge and merge on their way to the lymph node and do not cross each other in humans, demarking and dividing the skin into certain lymphatic territories, which are referred to as lymphosomes.…”