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Superficial Lymphatic System of the Upper Torso: Preliminary Radiographic Results in Human Cadavers

Suami, Hiroo M.D., Ph.D.; O'Neill, Jennifer K. B.M.B.Ch., M.R.C.S.; Pan, Wei-Ren M.D.; Taylor, G Ian M.D.

Plastic & Reconstructive Surgery: April 2008 - Volume 121 - Issue 4 - pp 1231-1239
doi: 10.1097/01.prs.0000302511.21140.36
Reconstructive: Trunk: Original Articles

Background: Lymphoscintigraphy has become a routine examination for identifying the sentinel lymph node in various cancer patients. Despite increasing clinical information, the basic anatomy of the superficial lymphatic system of the upper torso has not been fully elucidated.

Methods: Five female breasts, three anterior chest walls, and three forequarter specimens from fresh nine cadavers (two male and seven female) were used for this study. Our original radiographic method for delineating the lymphatics was applied. The course of the lymph vessels was traced from the x-ray films and color coded in accordance with their sentinel lymph node to define the lymph territories of the upper torso. In addition, cross-sectional studies were performed on the female breasts to demonstrate the three-dimensional pathway and connections of the lymphatic vessels.

Results: The lymphatic territories of the upper torso were divided by the midaxillary line. The anterior side drained into the external mammary or axillary vein lymph nodes and the posterior side drained into the scapular nodes. There was no significant difference between sexes. In most cases, one sentinel lymph node in the axilla notably covered a large lymph territory in both the upper arm and the upper torso.

Conclusions: The authors have demonstrated by radiography and dissection the superficial lymphatics of the upper torso in male and female cadavers. The lymph vessels originating in the lower region of the upper torso have close spatial association with the breast tissue and seemed to play a key role in the breast lymph drainage.

Parkville, Victoria, Australia

From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Royal Melbourne Hospital, Department of Anatomy and Cell Biology, University of Melbourne.

Received for publication November 14, 2006; accepted January 10, 2007.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Hiroo Suami, M.D., Ph.D., The Jack Brockhoff Reconstructive Plastic Surgery Research Unit, E533 Medical Building, Department of Anatomy and Cell Biology, University of Melbourne, Grattan Street, Parkville 3050, Victoria, Australia, hsuami@unimelb.edu.au

©2008American Society of Plastic Surgeons