Lymphatic anatomy and lymphœdema

Abstract

Summary 1.All cases of clinical lymphœdema show gross anatomical abnormality of the lymphatic vessels, which may be absence, hypoplasia, discontinuity, varicosity with valvular incompetence, or obstruction. Comparable gross changes have not been found in patients suffering from œdema due to other causes, though the obstructive pattern may occur locally without œdema developing. 2.The concept of an anatomical barrier between superficial and deep lymphatic systems in a limb is shown to be a myth. Moreover, the deep vessels do share in the pathological changes which affect the superficial group, at any rate in obstructive lymphœdema. Rerouting through the deep system can occur where there is obstruction to superficial lymphatic drainage only. 3.Clinical X-ray lymphangiography can supply information which will allow a rational approach to be made to treatment of individual cases of lymphœdema. Probably the grafting of lymphatic tissue should be reserved for limbs showing localised proximal lymphatic obstruction, diagnosed early enough to anticipate irreversible changes occurring in the peripheral vessels. Reflux of dye into the dermal plexus, which is characteristic of proximal lymphatic obstruction, makes the diagnosis possible without the need for lymphatic cannulation.