From the Division of Plastic and Reconstructive Surgery and Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; and Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.
Plast Reconstr Surg. 2022 Oct 1;150(4):900-907. doi: 10.1097/PRS.0000000000009555. Epub 2022 Aug 4.
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.
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.
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.
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.
由于淋巴管的尺寸较小，难以成像，因此人类对详细的淋巴解剖结构的了解有限。目前对浅表淋巴系统的大部分了解都是通过尸体解剖获得的。
在没有临床或客观淋巴水肿证据的乳腺癌患者中，术前进行吲哚菁绿淋巴造影术以绘制功能性臂淋巴管图。进行回顾性研究以提取人口统计学，吲哚菁绿成像和手术数据。
确定了三个主要的功能性前臂通道，它们与两条上臂通道具有不同的连接。前臂的中静脉通道主要在前臂的掌侧（99％）中。在大多数患者中，尺侧前臂通道在前臂的掌侧中（66％）。桡侧前臂通道在大多数患者中（92％）在前臂的背侧中。正中（100％），桡侧（91％）和尺侧（96％）通道几乎普遍连接到上臂的内侧通道。相比之下，从桡侧（40％）和尺侧（31％）通道向外侧上臂通道的连接发生的频率较低。
这项研究详细描述了活体成年人中无淋巴疾病的三个前臂淋巴管及其与上臂的连接。了解这些途径和变异与任何在四肢上进行手术的个体都相关，因为浅表淋巴系统的损伤可能使患者容易发生淋巴水肿。
