Scaglioni Mario F, Suami Hiroo
Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Plast Reconstr Aesthet Surg. 2015 Mar;68(3):419-27. doi: 10.1016/j.bjps.2014.10.047. Epub 2014 Nov 11.
Vascularized lymph node transfer (VLNT) has shown promise as a treatment for breast cancer-related lymphedema, a common and debilitating condition among breast cancer survivors. In VLNT, the most popular lymph node flap donor site is the inguinal region; however, concerns about the possibility of iatrogenic lymphedema hamper the widespread adoption of VLNT. A better understanding of the anatomy of the lymphatic system in the inguinal region is essential to preserving lymph drainage in the leg and avoiding iatrogenic lymphedema.
Five human cadaver hind-quarter specimens were used for this study. First, the specimens were scanned with indocyanine green fluorescence lymphography to map the lymphatic vessels. A dual injection technique using different radiocontrast media was then applied to delineate arteries and lymphatic vessels on radiographs. Finally, radiological analysis and meticulous dissection were used to investigate relationships between the arteries and lymphatic vessels.
By chasing the lymphatic vessels retrogradely from their corresponding lymph nodes, we were able to divide the superficial inguinal lymph nodes into three subgroups: the abdominal, medial thigh, and lateral thigh nodes. We found no connections between the superficial and deep lymphatic system in the inguinal region. The dominant lymph nodes draining the leg were in the lower part of the inguinal triangle, and their efferent lymphatic vessels ran medial to the common femoral artery.
Preserving the sentinel nodes of the lower leg in the medial thigh and their efferent lymphatic vessels is crucial to avoid iatrogenic lymphedema in limbs with donor sites for VLNT.
血管化淋巴结转移术（VLNT）已显示出有望成为治疗乳腺癌相关淋巴水肿的方法，这是乳腺癌幸存者中一种常见且使人衰弱的病症。在VLNT中，最常用的淋巴结皮瓣供区是腹股沟区；然而，对医源性淋巴水肿可能性的担忧阻碍了VLNT的广泛应用。更好地了解腹股沟区淋巴系统的解剖结构对于保留腿部淋巴引流和避免医源性淋巴水肿至关重要。
本研究使用了五具人类尸体后肢标本。首先，用吲哚菁绿荧光淋巴造影术对标本进行扫描以绘制淋巴管。然后应用使用不同放射性造影剂的双重注射技术在X线片上描绘动脉和淋巴管。最后，通过放射学分析和细致解剖来研究动脉与淋巴管之间的关系。
通过从相应淋巴结逆行追踪淋巴管，我们能够将腹股沟浅淋巴结分为三个亚组：腹部、大腿内侧和大腿外侧淋巴结。我们发现腹股沟区浅、深淋巴系统之间没有连接。引流腿部的主要淋巴结位于腹股沟三角的下部，其输出淋巴管在股总动脉内侧走行。
保留大腿内侧小腿的前哨淋巴结及其输出淋巴管对于避免在有VLNT供区的肢体中发生医源性淋巴水肿至关重要。
