Abstract
The anatomy of the lymphatic system is the least studied field in gross anatomical research. Our current knowledge about the normal anatomy of the lymphatic system still largely depends on dissection studies performed using the mercury injection technique in cadavers over 100 years ago. In addition, there has been insufficient investigation from the anatomical perspective of the pathophysiology of lymphoedema that develops congenitally or after cancer treatment. The recent development of a new cadaver dissection technique by the authors and use of indocyanine green fluorescence lymphography in the clinical setting have enabled us to visualise the anatomical structure of the lymphatic system and provide further understanding about normal lymphatic anatomy and the structural alterations that occur in lymphoedema.
Highlighted References
Kinmonth JB, Taylor GW. Spontaneous rhythmic contractility in human lymphatics. J Physiol Lond. 1956;133:3.
Leak LV, Burke JF. Ultrastructural studies on the lymphatic anchoring filaments. J Cell Biol. 1968;36:129–49.
Mascagni P. Vasorum Lymphaticorum Corporis Humani Historia et Ichonographia. P. Carli: Sienne; 1787.
Suami H, Taylor GI, Pan WR. A new radiographic cadaver injection technique for investigating the lymphatic system. Plast Reconstr Surg. 2005;115:2007–13.
Sappey PC. Anatomie, Physiologie, Pathologie des Vaisseaux Lymphatiques consideres chez L’Homme et les Vertebres. Paris: Adrien Delahaye; 1874.
References
Kato S, Suami H. Atarashii Rinpagaku. Kyoto: Kinpodo Inc., Japan; 2015.
Wenzel-Hora BI, Berens von Rautenfeld D, Majewski A, et al. Scanning electron microscopy of the initial lymphatics of the skin after use of the indirect application technique with glutaraldehyde and MERCOX as compared to clinical findings. Lymphology. 1987;20:126–44.
Suami H, Pan WR, Mann GB, Taylor GI. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol. 2008;15:863–71.
Mislin H. Structural and functional relations of the mesenteric lymph vessels. New trends in basic lymphology; proceedings of a symposium held at Charleroi, Belgium; July 11-13, 1966. Experientia Suppl. 1966;14:87–96.
Gashev AA, Zawieja DC. Physiology of human lymphatic contractility: a historical perspective. Lymphology. 2001;34:124–34.
Baluk P, Fuxe J, Hashizume H, et al. Functionally specialized junctions between endothelial cells of lymphatic vessels. J Exp Med. 2007;204:2349–62.
Leak LV. Electron microscopic observations on lymphatic capillaries and the structural components of the connective tissue-lymph interface. Microvasc Res. 1970;2:361–91.
Suami H, Taylor GI, Pan WR. The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg. 2007;119:1813–22.
Suami H. Lymphosome concept: Anatomical study of the lymphatic system. J Surg Oncol. 2016;115(1):13–7.
Bartels P. Das Lymphgefasssystem. Gustav Fischer: Jene; 1909.
Suami H, Pan WR, Taylor GI. Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver. Plast Reconstr Surg. 2007;120:982–91.
Suami H, Scaglioni MF, Dixon KA, Tailor RC. Interaction between vascularized lymph node transfer and recipient lymphatics after lymph node dissection- a pilot study in a canine model. J Surg Res. 204(2):418–27.
Tomusyak TL. Regeneration of lymphatics after extirpation of lymph glands. Bull Exp Biol Med. 1969;68:933–6.
Ikomi F, Yokoyama Y, Ogiwara N, et al. Recanalization of the collecting lymphatics in rabbit hind leg. Microcirculation. 2006;13:365–76.
Suami H, Taylor GI, O'Neill J, Pan WR. Refinements of the radiographic cadaver injection technique for investigating minute lymphatic vessels. Plast Reconstr Surg. 2007;120:61–7.
Battezzati M, Donini I. The Lymphatic System. Padua and London: Piccin Medical Books; 1972.
Suami H, O'Neill JK, Pan WR, Taylor GI. Superficial lymphatic system of the upper torso: preliminary radiographic results in human cadavers. Plast Reconstr Surg. 2008;121:1231–9.
Scaglioni MF, Suami H. Lymphatic anatomy of the inguinal region in aid of vascularized lymph node flap harvesting. J Plast Reconstr Aesthet Surg. 2015;68:419–27.
Ito R, Suami H. Lymphatic Territories (Lymphosomes) in swine: an animal model for future lymphatic research. Plast Reconstr Surg. 2015;136:297–304.
Yamazaki S, Suami H, Imanishi N, et al. Three-dimensional demonstration of the lymphatic system in the lower extremities with multi-detector-row computed tomography: a study in a cadaver model. Clin Anat. 2013;26:258–66.
Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema - Long-term results following microsurgical lymph node transplantation. Ann Surg. 2006;243:313–5.
Viitanen TP, Maki MT, Seppanen MP, et al. Donor-site lymphatic function after microvascular lymph node transfer. Plast Reconstr Surg. 2012;130:1246–53.
Dayan JH, Dayan E, Smith ML. Reverse lymphatic mapping: a new technique for maximizing safety in vascularized lymph node transfer. Plast Reconstr Surg. 2015;135:277–85.
Kubik S, Kretz O. Anatomy of the lymphatic system. In: Foldi M, Foldi E, editors. Foldi's textbook of lymphology for physicians and lymphedema therapists. Munich: Elsevier GmbH; 2006. p. 1–149.
Irrthum A, Karkkainen MJ, Devriendt K, et al. Congenital hereditary lymphedema caused by a mutation that inactivates VEGFR3 tyrosine kinase. Am J Hum Genet. 2000;67:295–301.
Dale RF. Primary lymphoedema when found with distichiasis is of the type defined as bilateral hyperplasia by lymphography. J Med Genet. 1987;24:170–1.
Jackson RJ. A study of the lymphatics of the lower limb in the normal state and after inguinal lymphadenectomy. J Obstet Gynaecol Br Commonw. 1966;73:71–87.
Kinmonth JB. The Lymphatics, Diseases, Lymphography and Surgery. London: Edward Arnold; 1972.
Weissleder H, Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology. 1988;167:729–35.
Suami H, Chang DW, Yamada K, Kimata Y. Use of indocyanine green fluorescent lymphography for evaluating dynamic lymphatic status. Plast Reconstr Surg. 2011;127:74e–6e.
Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg. 2013;132:1305–14.
Suami H, Pan WR, Taylor GI. The lymphatics of the skin filled by a dermal backflow: an observation in a scarred cadaver leg. Lymphology. 2007;40:122–6.
Acknowledgements
I thank the Department of Neurobiology and Anatomy at the University of Texas Medical School at Houston for assisting in cadaver dissection studies and the Department of Plastic Surgery at the University of Texas MD Anderson Cancer Center for organising capital equipment. I thank Dianna Cody, Ph.D., from the Department of Imaging Physics MD Anderson Center for Advanced Biomedical Imaging for taking computed tomography images of cadaver specimens and Shun Yamazaki, M.D., at the Department of Plastic and Reconstructive Surgery, Ryukyu University Hospital, Okinawa, Japan, for composing 3D images and video from the imaging data in ◘ Fig. 5.8. I also thank Mr. Michael Gallagher for producing the professional medical illustration in ◘ Fig. 5.14 and Philippa Sutton at the Faculty of Medicine and Health Sciences, Macquarie University, for her professional editing of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
1 Electronic Supplementary Material
Three-dimensional volume-rendering image of the upper extremity and torso lymphatic vessels (green) in a cadaver forequarter (Published with kind permission of © Hiroo Suami 2017) (WMV 7723 kb)
ICG fluorescence lymphography image in a cadaver upper extremity (WMV 73621 kb)
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Suami, H., Kato, S. (2018). Anatomy of the Lymphatic System and Its Structural Disorders in Lymphoedema. In: Lee, BB., Rockson, S., Bergan, J. (eds) Lymphedema. Springer, Cham. https://doi.org/10.1007/978-3-319-52423-8_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-52423-8_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-52421-4
Online ISBN: 978-3-319-52423-8
eBook Packages: MedicineMedicine (R0)