Fanning James E, Friedman Rosie, Chen Angela, Bustos Valeria, Aly Mohamed Ismail, Fleishman Aaron, Hong Young Kwon, Tsai Leo, Parker John A, Donohoe Kevin, Singhal Dhruv
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Keck School of Medicine of USC, Los Angeles, California, USA.
Ann Surg. 2024 Oct 1. doi: 10.1097/SLA.0000000000006550.
We evaluated whether superficial lymphatic anatomy and functional lymph node drainage are symmetric between the right and left upper extremities of healthy female volunteers, and if handedness is associated with symmetry of superficial lymphatic anatomy.
Symmetry of lymphatic anatomy has been assumed historically. This assumption of individual anatomic symmetry is being utilized clinically and in research without validation.
36 normal female volunteers underwent bilateral indocyanine green (ICG) lymphography and lymphoscintigraphy of the upper extremities. Eight collecting vessel pathways of each upper extremity were mapped on ICG lymphography. 13 lymph node groups were visualized on lymphoscintigraphy. Symmetry of lymphatic anatomy and functional drainage were established by comparing the right and left extremities of each participant. Hand dominance was assessed by hand grip strength on a hand dynamometer.
Among the 36 participants, 10 (28%) showed symmetry of all eight upper extremity lymphatic pathways with ICG. However, only 1 (3%) participant demonstrated complete symmetry amongst the 13 lymph node groups. Total symmetry of lymphatic channels was observed on ICG in seven (39%) participants with hand dominance and three (17%) participants without hand dominance (X2 = 2.215, P = 0.137).
Lymphatic anatomy and functional drainage of the upper extremities are not consistently symmetric. Functional nodal drainage as demonstrated by lymphoscintigraphy shows less symmetry than anatomic studies of lymphatic channels using ICG. Symmetric lymphatic anatomy does not appear to correlate with hand dominance. These findings challenge the prevailing assumption of left-right lymphatic symmetry.
我们评估了健康女性志愿者左右上肢的浅表淋巴解剖结构和功能性淋巴结引流是否对称，以及利手是否与浅表淋巴解剖结构的对称性相关。
淋巴解剖结构的对称性在历史上一直被假定。这种个体解剖对称性的假设在临床和研究中未经验证就被使用。
36名正常女性志愿者接受了双侧上肢吲哚菁绿（ICG）淋巴造影和淋巴闪烁显像。在ICG淋巴造影上绘制每个上肢的8条收集血管路径。在淋巴闪烁显像上观察到13个淋巴结组。通过比较每个参与者的左右上肢来确定淋巴解剖结构和功能性引流的对称性。通过手握力计评估手的优势度。
在36名参与者中，10名（28%）在ICG检查中显示所有8条上肢淋巴路径对称。然而，只有1名（3%）参与者在13个淋巴结组中表现出完全对称。在ICG检查中，7名（39%）有手优势的参与者和3名（17%）无手优势的参与者观察到淋巴通道完全对称（X2 = 2.215，P = 0.137）。
上肢的淋巴解剖结构和功能性引流并非始终对称。淋巴闪烁显像显示的功能性淋巴结引流对称性低于使用ICG对淋巴通道进行的解剖学研究。对称的淋巴解剖结构似乎与手优势无关。这些发现挑战了普遍存在的左右淋巴对称的假设。
