Download PDF
J Reconstr Microsurg 2024; 40(09): 672-679
DOI: 10.1055/s-0044-1782670
Original Article

Mapping the Anatomy of the Human Lymphatic System

Valeria P. Bustos
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Robin Wang
2   Department of Radiology, Stanford University School of Medicine, Stanford, California
,
Jaime Pardo
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Avinash Boppana
3   Revela Inc., Woburn, Massachusetts
,
Griffin Weber
4   Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Max Itkin
5   Nemours Children's Hospital, Penn Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
,
Dhruv Singhal
1   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding Research reported in this publication was partially supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (https://www.nhlbi.nih.gov/) and Common Fund (https://commonfund.nih.gov/) under Award Numbers R01HL157991 (D.S.) and U54HL165440 (D.S./M.I.).
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background While substantial anatomical study has been pursued throughout the human body, anatomical study of the human lymphatic system remains in its infancy. For microsurgeons specializing in lymphatic surgery, a better command of lymphatic anatomy is needed to further our ability to offer surgical interventions with precision. In an effort to facilitate the dissemination and advancement of human lymphatic anatomy knowledge, our teams worked together to create a map. The aim of this paper is to present our experience in mapping the anatomy of the human lymphatic system.

Methods Three steps were followed to develop a modern map of the human lymphatic system: (1) identifying our source material, which was “Anatomy of the human lymphatic system,” published by Rouvière and Tobias (1938), (2) choosing a modern platform, the Miro Mind Map software, to integrate the source material, and (3) transitioning our modern platform into The Human BioMolecular Atlas Program (HuBMAP).

Results The map of lymphatic anatomy based on the Rouvière textbook contained over 900 data points. Specifically, the map contained 404 channels, pathways, or trunks and 309 lymph node groups. Additionally, lymphatic drainage from 165 distinct anatomical regions were identified and integrated into the map. The map is being integrated into HuBMAP by creating a standard data format called an Anatomical Structures, Cell Types, plus Biomarkers table for the lymphatic vasculature, which is currently in the process of construction.

Conclusion Through a collaborative effort, we have developed a unified and centralized source for lymphatic anatomy knowledge available to the entire scientific community. We believe this resource will ultimately advance our knowledge of human lymphatic anatomy while simultaneously highlighting gaps for future research. Advancements in lymphatic anatomy knowledge will be critical for lymphatic surgeons to further refine surgical indications and operative approaches.

Keywords

anatomy - lymphatic system - map


Publication History

Received: 18 November 2023

Accepted: 20 February 2024

Article published online:
28 March 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Swartz MA. The physiology of the lymphatic system. Adv Drug Deliv Rev 2001; 50 (1-2): 3-20
    CrossrefPubMedGoogle Scholar
  • 2 Breslin JW, Yang Y, Scallan JP, Sweat RS, Adderley SP, Murfee WL. Lymphatic vessel network structure and physiology. Compr Physiol 2018; 9 (01) 207-299
    CrossrefPubMedGoogle Scholar
  • 3 Sappey PC. Anatomie, Physiologie, Pathologie Des Vaisseaux Lymphatiques Considérés Chez l'homme et Les Vertébrés. (Delahaye A, ed.). Paris; 1874 https://archive.org/details/BIUSante_01562 Accessed October 20, 2023
    PubMed
  • 4 Itkin M, Rockson SG, Burkhoff D. Pathophysiology of the lymphatic system in patients with heart failure: JACC state-of-the-art review. J Am Coll Cardiol 2021; 78 (03) 278-290
    CrossrefPubMedGoogle Scholar
  • 5 Loukas M, Bellary SS, Kuklinski M. et al. The lymphatic system: a historical perspective. Clin Anat 2011; 24 (07) 807-816
    CrossrefPubMedGoogle Scholar
  • 6 Ciucci JL, Vadra GD, Sorocco J. Investigación anatómica del drenaje linfático del miembro superior: su importancia en la patología traumatológica. Rev Asoc Arg Ortop y Traumatol 1996;62
    PubMedGoogle Scholar
  • 7 Latorre J, Ciucci JL, Rosendo A. Anatomía del sistema linfático del miembro superior. An Cir Card y Vasc 2004; 10 (03) 184-198
    PubMedGoogle Scholar
  • 8 Lauringer E. Nova exercitatio anatomica, exhibens ductus hepaticos aquosos, & vasa glandularum serosa, nunc primum inventa, æneisque figuris delineata. 1653;First edit. https://www.sophiararebooks.com/pages/books/5101/olof-rudbeck/nova-exercitatio-anatomica-exhibens-ductus-hepaticos-aquosos-vasa-glandularum-serosa-nunc . Accessed October 21, 2023
    PubMed
  • 9 Mascagni P. Vasorum lymphaticorum corporis humani historia et ichnographia. | Anatomia Collection: anatomical plates 1522–1867. Accessed July 30, 2022 at: https://anatomia.library.utoronto.ca/islandora/object/anatomia%3ARBAI052
    PubMed
  • 10 Suami H, Pan WR, Mann GB, Taylor GI. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol 2008; 15 (03) 863-871
    CrossrefPubMedGoogle Scholar
  • 11 Rouvière H, Tobias MJ. Anatomy of the Human Lymphatic System. Ann Arbor, Mich, Edwards Brothers, Inc.; 1938
    Google Scholar
  • 12 Kubik S. [Anatomy of the lymphatic system]. Radiol Clin Biol 1973; 42 (04) 243-257
    PubMedGoogle Scholar
  • 13 Leduc A, Caplan I, Leduc O. Lymphatic drainage of the upper limb. Eur J Lymphology 1993;4(13):
    PubMedGoogle Scholar
  • 14 Amore M, Tapia L, Mercado D, Pattarone G, Ciucci J. Lymphedema: a general outline of its anatomical base. J Reconstr Microsurg 2016; 32 (01) 2-9
    PubMedGoogle Scholar
  • 15 Suami H, Taylor GI, Pan W-R. The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg 2007; 119 (06) 1813-1822
    CrossrefPubMedGoogle Scholar
  • 16 Suami H, Scaglioni MF. Anatomy of the lymphatic system and the lymphosome concept with reference to lymphedema. Semin Plast Surg 2018; 32 (01) 5-11
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Pan W-R, Le Roux CM, Briggs CA. Variations in the lymphatic drainage pattern of the head and neck: further anatomic studies and clinical implications. Plast Reconstr Surg 2011; 127 (02) 611-620
    CrossrefPubMedGoogle Scholar
  • 18 Johnson AR, Bravo MG, James TA, Suami H, Lee BT, Singhal D. The all but forgotten Mascagni-Sappey pathway: learning from immediate lymphatic reconstruction. J Reconstr Microsurg 2020; 36 (01) 28-31
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Friedman R, Bustos VP, Pardo J. et al. Superficial and functional imaging of the tricipital lymphatic pathway: a modern reintroduction. Breast Cancer Res Treat 2023; 197 (01) 235-242
    CrossrefPubMedGoogle Scholar
  • 20 The Human BioMolecular Atlas Program - HuBMAP | NIH Common Fund. Accessed March 25, 2022 at: https://commonfund.nih.gov/hubmap
    PubMed
  • 21 Anatomy of the human lymphatic system. By H. Rouvière, Professor of Anatomy at the Medical Faculty of Paris, France. A compendium translated from the original Anatomie des Lymphatiques de l'Homme by M.J. Tobias, formerly of the Department of Anatomy, New York University. 103/4 × 81/4 in. Pp. 318 + ix, with 129 illustrations. 1938. Ann Arbor, Michigan: Edwards Bros. Inc. $400. Br J Surg 1939; 27 (105) 194-195
    CrossrefPubMedGoogle Scholar
  • 22 The Visual Collaboration Platform for Every Team | Miro. Accessed March 25, 2022 at: https://miro.com/
    PubMed
  • 23 Granoff MD, Pardo J, Shillue K. et al. Variable anatomy of the lateral upper arm lymphatic channel: a potential anatomic risk factor for the development of breast cancer related lymphedema. Plast Reconstr Surg 2023; 152 (02) 422-429
    CrossrefPubMedGoogle Scholar
  • 24 Granoff MD, Pardo JA, Johnson AR. et al. Superficial and functional lymphatic anatomy of the upper extremity. Plast Reconstr Surg 2022; 150 (04) 900-907
    CrossrefPubMedGoogle Scholar
  • 25 Chen WF, Knackstedt R. Delayed distally based prophylactic lymphaticovenular anastomosis: improved functionality, feasibility, and oncologic safety?. J Reconstr Microsurg 2020; 36 (09) e1-e2
    Article in Thieme ConnectPubMedGoogle Scholar