The lymphatics of the lower limb Fig 431

The lymph nodes of the groin are arranged into superficial and deep groups. The superficial inguinal group lie in the superficial fascia and are arranged in two chains:

• Longitudinal chain: these lie along the terminal portion of the saphenous vein. They receive lymph from the majority of the superficial tissues of the lower limb.

• Horizontal chain: these lie parallel to the inguinal ligament. They receive lymph from the superficial tissues of the: lower trunk below the level of the umbilicus, the buttock, the external genitalia and the lower half of the anal canal. The superficial nodes drain into the deep nodes through the saphenous opening in the deep fascia.

The deep inguinal nodes are situated medial to the femoral vein. They are usually three in number. These nodes receive lymph from all of the tissues deep to the fascia lata of the lower limb. In addition they also receive lymph from the skin and superficial tissues of the heel and lateral aspect of the foot by way of the popliteal nodes. The deep nodes convey lymph to external iliac and thence to the para-aortic nodes.

Obstruction of lymphatics results in lymphoedema (Fig. 43.3). This can be congenital, due to aberrant lymphatic formation, or acquired such as post radiotherapy or following certain infections. In developing countries infection with Filaria bancrofti is a significant cause of lymphoedema that can progress to massive proportions requiring limb reduction or even amputation.

The veins and lymphatics of the lower limb 97

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