From the Division of Plastic and Reconstructive Surgery.
Department of Rehabilitation Services.
Plast Reconstr Surg. 2023 Aug 1;152(2):422-429. doi: 10.1097/PRS.0000000000010245. Epub 2023 Jan 24.
The lateral upper arm channel is an accessory lymphatic pathway that drains the upper extremity by means of the deltopectoral groove and supraclavicular nodes, thereby bypassing the axilla. Its variable connectivity to the forearm has not been studied in vivo.
Indocyanine green (ICG) lymphography was performed preoperatively to map the superficial and functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, ICG imaging, and surgical data.
Sixty patients underwent ICG lymphography before axillary lymph node dissection between June of 2019 and October of 2020. In 59%, the lateral upper arm lymphatic channel was contiguous with the forearm (long bundle). In 38%, the lateral upper arm lymphatic channel was present but not contiguous with the forearm (short bundle). In 3%, the lateral upper arm pathway was entirely absent. Seven patients developed at least one sign of lymphedema during postoperative surveillance, of which 71% demonstrated the short bundle variant.
Although the lateral upper arm pathway is most often present, its connections to the forearm are frequently absent (short bundle), which, in this pilot report, appears to represent a potential risk factor for the development of lymphedema.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, V.
外侧上臂通道是一条辅助性淋巴通路，通过肩峰下和胸锁乳突肌间沟引流上肢，从而绕过腋窝。其与前臂的连接具有变异性，尚未在体内进行研究。
在没有临床或客观淋巴水肿证据的情况下，对乳腺癌患者进行术前吲哚菁绿（ICG）淋巴造影术，以绘制上肢浅表和功能性淋巴管图。回顾性分析提取人口统计学、ICG 成像和手术数据。
2019 年 6 月至 2020 年 10 月，60 例患者在腋窝淋巴结清扫术前行 ICG 淋巴造影术。在 59%的患者中，外侧上臂淋巴管与前臂（长束）连续。在 38%的患者中，外侧上臂淋巴管存在但与前臂不连续（短束）。在 3%的患者中，外侧上臂通路完全缺失。在术后监测中，有 7 例患者至少出现一种淋巴水肿征象，其中 71%表现为短束变异。
尽管外侧上臂通路最常见，但它与前臂的连接常常缺失（短束），在本初步报告中，这似乎是淋巴水肿发展的一个潜在危险因素。
临床问题/证据水平：风险，V 级。
