Anatomy of the Lymphatic System and the Lymphosome Concept with Reference to Lymphedema

Hiroo Suami; Mario F. Scaglioni

doi:10.1055/s-0038-1635118

Seminars in Plastic Surgery, Table of Contents

Semin Plast Surg 2018; 32(01): 005-011
DOI: 10.1055/s-0038-1635118

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anatomy of the Lymphatic System and the Lymphosome Concept with Reference to Lymphedema

Authors

Hiroo Suami

¹Australian Lymphoedema Education Research Treatment Centre (ALERT), Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
Mario F. Scaglioni

²Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland

Abstract

Precise knowledge of the lymphatic system normal anatomy is essential for understanding what structural changes occur in patients with lymphedema. In this article, the authors first review previous anatomical studies and summarize the general anatomy of the lymphatic system and lymphatic pathways in the upper and lower extremities. Second, they introduce their new anatomical concept, the “lymphosome,” which describes how the lymphatic vessels in a particular region connect to the same subgroup of regional lymph nodes. In addition, they describe the anatomical relationship between the perforating lymphatic vessels and arteries. In the last section, they explain the anatomical changes in the lymphatics after lymph node dissection, with reference to secondary lymphedema.

Keywords

lymph capillary - precollector - lymph collecting vessel - lymphosome - sentinel node

Full Text

References

References
1 Yoffey JM, Courtice FC. Lymphatics, Lymph and the Lymphomyeloid Complex. London and New York: Academic Press; 1970
2 Sappey MPC. Anatomie, Physiologie, Pathologie Des Vaisseaux Lymphatiques. Paris: AdrienDelahaye; 1874
3 Uren RF, Hoefnagal CA. Lymphoscintigraphy. In: Thompson JF, Morton DL, Kroon BBR. , eds. Textbook of Melanoma. London and New York: Taylor & Francis; 2004
4 Rockson SG. Genetic prospects for lymphedema management. In: Lee BB, Bergan J, Rockson SG. , eds. Lymphedema A Concise Compendium of Theory and Practice. London: Springer; 2011
5 Suami H, Pan WR, Mann GB, Taylor GI. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol 2008; 15 (03) 863-871
6 Leak LV. Electron microscopic observations on lymphatic capillaries and the structural components of the connective tissue-lymph interface. Microvasc Res 1970; 2 (04) 361-391
7 Bartels P. Das Lymphgefasssystem. Jene: Gustav Fischer; 1909
8 Jossifow GM. Das Lymphgefäßsystem des Menchen. Jena: Verlag von Gustav Fischer; 1930
9 Suami H, Taylor GI, Pan WR. A new radiographic cadaver injection technique for investigating the lymphatic system. Plast Reconstr Surg 2005; 115 (07) 2007-2013
10 Suami H, Taylor GI, O'Neill J, Pan WR. Refinements of the radiographic cadaver injection technique for investigating minute lymphatic vessels. Plast Reconstr Surg 2007; 120 (01) 61-67
11 Suami H. Lymphosome concept: anatomical study of the lymphatic system. J Surg Oncol 2017; 115 (01) 13-17
12 Uren RF, Thompson JF, Howman-Glies RB. Lymphatic Drainage of the Skin and Breast. Amsterdam: Harwood Academic Publishers; 1999
13 Gray JH. Studies of the regeneration of lymphatic vessels. J Anat 1940; –40; 74 (Pt 3): 309-335
14 Suami H, Scaglioni MF, Dixon KA, Tailor RC. Interaction between vascularized lymph node transfer and recipient lymphatics after lymph node dissection-a pilot study in a canine model. J Surg Res 2016; 204 (02) 418-427
15 Nguyen AT, Suami H, Hanasono MM, Womack VA, Wong FC, Chang EI. Long-term outcomes of the minimally invasive free vascularized omental lymphatic flap for the treatment of lymphedema. J Surg Oncol 2017; 115 (01) 84-89