The anatomical variations in accessory lymphatic pathways
around the axillary region may work as a drainage route for excess lymphatic fluid accumulation in secondary upper extremity lymphedema
. In this report, accessory lymphatic pathways
extending to the shoulder, neck, and breast regions in secondary upper extremity lymphedema
patients are shown using indocyanine green (ICG) lymphography.
Patients and Methods
Between January 2012 and May 2015, 30 limbs of 29 patients with upper extremity lymphedema
after malignant tumor resection were evaluated. ICG lymphography
was performed after chronic lymphedema
Of the 30 limbs, accessory lymphatic pathways
were identified across the axillary region in 3 patients using ICG lymphography
. In 2 of these 3 patients, accessory drainage lymphatics were connected to the cervical lymph nodes. In regard to the distribution of dermal backflow patterns, dermal backflow appeared in 26 patients—in the forearm in 26 patients and in the upper arm in 20 patients.
Conclusions Accessory lymphatic pathways
are thought to be the drainage routes in the affected arm, which may prevent edema progression to the terminal stage. Variations in the lymphatic system are easily visualized using ICG lymphography
. Understanding of accessory lymphatic routes in lymphedema
patients may provide new insight for further understanding the pathophysiology of lymphedema