Yang Johnson Chia-Shen
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Plast Reconstr Surg Glob Open. 2023 Dec 22;11(12):e5503. doi: 10.1097/GOX.0000000000005503. eCollection 2023 Dec.
Understanding the anatomical territories drained by lymphatic vessels (LVs) is essential for a better comprehension of lymphatic anatomy and functionality, and for performing lymphatic procedures such as lymphaticovenous anastomosis (LVA). However, current concepts regarding the lymphatic territory are insufficient to explain some of the clinical observations. As shown in the figures, within one incision for the LVA, one to two lymphatic vessels (LV) remained unenhanced on indocyanine green (ICG) lymphography, whereas the rest of the LVs were enhanced. To answer this question, one must examine the concept of the lymphosome, first described by Suami, defined as a particular region drained by LVs into the same subgroup of regional lymph nodes (LNs) (eg, superficial groin LNs). Suami's lymphosome concept represents "LN-based lymphosomes." In addition, Shinaoka identified four distinct lymphatic groups (anteromedial, anterolateral, posteromedial, and posterolateral) in the lower limbs after ICG injection. This represents the concept "group-based lymphosomes." Nevertheless, neither the LN- nor group-based lymphosome concepts offer an appropriate explanation for the clinical findings described above. In addition to the aforementioned lymphosome concepts, the author proposes a novel hypothesis called "lymphatic-based lymphosome," which considers each LV as a single lymphosome. Therefore, the normal-type LV remained unenhanced when ICG was not injected into the draining territory. To enhance post-LVA outcomes, an even distribution of anastomoses to different group-based lymphosomes is important, as is avoiding performing all anastomoses onto a single LV or within the same group-based lymphosome.
了解淋巴管（LVs）引流的解剖区域对于更好地理解淋巴解剖结构和功能，以及进行诸如淋巴管静脉吻合术（LVA）等淋巴手术至关重要。然而，目前关于淋巴区域的概念不足以解释一些临床观察结果。如图所示，在进行LVA的一个切口内，在吲哚菁绿（ICG）淋巴造影中一到两根淋巴管（LV）未显影，而其余的淋巴管显影。为了回答这个问题，必须研究淋巴小体的概念，这一概念最早由Suami提出，定义为由淋巴管引流至同一区域淋巴结（LNs）亚组（如腹股沟浅淋巴结）的特定区域。Suami的淋巴小体概念代表“基于淋巴结的淋巴小体”。此外，Shinaoka在注射ICG后在下肢识别出四个不同的淋巴组（前内侧、前外侧、后内侧和后外侧）。这代表了“基于组的淋巴小体”概念。然而，基于淋巴结和基于组的淋巴小体概念都无法对上述临床发现提供恰当解释。除了上述淋巴小体概念外，作者提出了一种名为“基于淋巴管的淋巴小体”的新假说，该假说将每根淋巴管视为一个单独的淋巴小体。因此，当未将ICG注入引流区域时，正常类型的淋巴管未显影。为了提高LVA术后效果，将吻合口均匀分布到不同的基于组的淋巴小体很重要，避免将所有吻合操作都在一根淋巴管上或同一基于组的淋巴小体内进行也同样重要。
