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

Pan, Wei‐Ren; Zeng, Fan-Qiang; Wang, Deguang; Qiu, Zhiqiang

doi:10.1111/ans.13893

Cited by 11 publications

(6 citation statements)

References 9 publications

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“…We believe that this is because of the pathway diving deeper into the extremity, perhaps connecting to the deep lymphatic system. 9,12 The above findings are commensurate with reports by Suami et al 4,9 Specifically, using the lymphosome concept, Suami et al noted that the majority of the lymphatic pathways from the hand and forearm flowed into the medial upper arm and into a sentinel lymph node in the axillary region. Moreover, Suami et al noted that pathways that passed along the dorsal aspect of the arm may bypass the main sentinel node in the axilla and reach smaller "sentry" nodes.…”

Section: Discussionsupporting

confidence: 83%

Superficial and Functional Lymphatic Anatomy of the Upper Extremity

Granoff

Pardo

Johnson

et al. 2022

Plastic &Amp; Reconstructive Surgery

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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.

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Section: Discussionsupporting

confidence: 83%

Superficial and Functional Lymphatic Anatomy of the Upper Extremity

Granoff

Pardo

Johnson

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Recalling the history of research conducted on the lymphatic system, it showed that the lymphatic anatomy of limbs was not available until the mercury infusion technique was applied [1][2][3][4]. Although the knowledge of the superficial and deep lymphatic anatomy of limbs has been updated during the last decade [5][6][7][8] the deep lymphatic anatomy of the foot remains the least described in medical literature.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical management requires accurate and detailed anatomical knowledge of the human lymphatic system. Although, the superficial and deep lymphatic anatomy in the lower limb has been updated during the last decade by using the new technique [1][2][3][4], but the deep lymphatic anatomy remained in uncertainty. Therefore, further study should be carried to renew the knowledge of the human lymphatic system to meet the needs of precise clinical management, modern education, and advanced scientific research.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2021

OAJBS

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Background: Detail of the deep lymphatic anatomy of the foot remains the least described in medical literature. Methods: Eight feet were harvested from four unembalmed human cadavers amputating above the ankle. A small amount of 6% hydrogen peroxide was used to find the deep lymphatic vessels around the dorsal and plantar metatarsal vessels. A fine needle was inserted into vessels and injected with a barium sulphate compound. Each specimen was dissected, photographed, and radiographed to demonstrate the deep lymphatic distribution of the foot. Results: Deep collecting lymph vessels of the foot were found in the deep tissue of the dorsal and sole of the foot, they were: Dorsal metatarsal lymph vessel (DMLV); Lateral tarsal lymph vessel (LTLV); Central tarsal lymph vessel (CTLV); Medial tarsal lymph vessel (MTLV); Dorsalis pedis lymph vessel (DPLV); Anterior lateral malleolus lymph vessel (ALMLV); Plantar metatarsal lymph vessel (PMLV); Deep plantar arch lymph vessel (DPALV); Lateral plantar lymph vessel (LPLV); Medial plantar lymph vessel (MPLV); Medial calcaneus lymph vessel (MCLV); Medial malleolus perforating lymph vessel (MMPLV). Each vessel ran concentrically, then merged successively and finally drained into the anterior or posterior tibial lymph vessels. Conclusion: The deep lymphatic distribution of the foot has been presented. The results will provide an anatomical basis for clinical management, educational reference, and scientific research.

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“…Thus, we postulated that the lymph node involvement presents in a lymphogenous phenotype of distal metastasis and that the difference in lymph node involvement is attributed to the anatomical difference between the regional lymph node network in upper and lower limbs. It can be interpreted as follows: upper limb lesions are most commonly located in the proximal humerus, close to neighboring axial nodes and vessels ( 26 ), while lower limb lesions are located near the knee joint, close to popliteal vessels but separated by muscle and interosseous membrane from the lymph network ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Regional lymph node involvement is associated with poorer survivorship in patients with upper extremity osteosarcoma than with lower extremity osteosarcoma: a SEER analysis

Xie¹,

Zeng²,

Tu³

et al. 2020

Transl Cancer Res TCR

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Background: Although the upper limb is the second most common site of osteosarcoma, investigations into clinical manifestation differences between upper and lower limb patients are still sporadic. We retrospectively investigated the characteristics of these patients to gain a better understanding of the differences between upper and lower limb osteosarcoma patients.Methods: This retrospective study involved patients diagnosed with extremity osteosarcoma between 1997 and 2016 collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patient characteristics were analyzed with t-tests, rank sum tests and chi-square tests. Log-rank tests were applied to evaluate univariate significance, and Cox hazards models were performed in multivariate analysis. A binary logistics regression model was used to screen the risk factors related to lymph node involvement.Results: In total, 1,882 patients, 1,588 (84.4%) with lower limb lesions and 294 (15.6%) with upper limb lesions were enrolled in our study. The patients with upper limb osteosarcoma exhibited poorer 5-year overall survival (OS) than patients with lower limb osteosarcoma (54.8% vs. 63.2%, P=0.02). The upper limb patients had more lymph node involvement (5.6% vs. 2.7%, P=0.03), which was found to be an independent prognostic factor (P=0.000). Tumors located in the upper limbs and the presence of distal metastasis were risk factors related to lymph node involvement in the extremity (P<0.05). The upper limb patients were tended to suffer greater risk of being affected by both metastasis and lymph node involvement (15.7% vs. 9.4%, P=0.18).Conclusions: Upper limb osteosarcoma patients are characterized by more lymph node involvement than lower limb patients, leading to poorer OS. In addition, upper limb patients are at greater risk for both lymph node involvement and distal metastasis. Our results suggest that upper limb patients should be screened more thoroughly for regional lymph node involvement.

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

Abstract: The perforating and deep lymphatic vessels in the knee region has been presented and discussed. The information advances our anatomical knowledge and the results will benefit clinical management.

Cited by 11 publications

References 9 publications

Superficial and Functional Lymphatic Anatomy of the Upper Extremity

Superficial and Functional Lymphatic Anatomy of the Upper Extremity

Untitled

Regional lymph node involvement is associated with poorer survivorship in patients with upper extremity osteosarcoma than with lower extremity osteosarcoma: a SEER analysis

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