PR23 ALTERATIONS IN THE LYMPH STRUCTURE OF THE UPPER LIMB FOLLOWING AXILLARY DISSECTION – RADIOGRAPHIC STUDY IN A HUMAN CADAVER

Abstract

Purpose There have been very few anatomical reports on the changing lymph structure of the upper limb after axillary dissection despite its clinical significance for predicting skin cancer recurrence in the limb and secondary lymphoedema. We used both upper limbs harvested from a fresh human cadaver who had undergone unilateral right radical mastectomy and radical axillary dissection for breast cancer.Methodology Hydrogen peroxide was used to identify and inflate the lymphatic vessels. Individual channels were injected with a radio‐opaque lead oxide mixture and recorded on X‐ray film.Results Results from the left normal upper limb were similar to results from our previous studies. However, the right limb from the mastectomy side showed remarkable differences as well as revealing that the lymph node clearance in the axilla had been incomplete on that side. The major difference was the almost complete absence of the superficial lymph collecting vessels in the right arm, proximal to the elbow, due to fibrosis and blockage of the lymphatic channels. A circuitous pathway was identified that by passed the blocked lymphatics in the arm to reach the deep system. This was often facilitated by backflow through precollectors and avalvular lymph capillaries in the dermis of the forearm, to eventually reach the few remaining lymph nodes in the axilla.Conclusions Previously undetected lymph channels connecting the superficial and the deep lymphatic system had opened up due to the blockage of superficial lymphatic vessels caused by axillary dissection. It is presumed that these channels prevented lymphoedema in this case.