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The Upper Extremity Lymphatic System Is Not Symmetrical in Individuals: An Anatomic Study Utilizing Indocyanine Green
James E Fanning1, Rosie Friedman1, Angela Chen1
1Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Annals of Surgery
|October 1, 2024
Summary
Superficial lymphatic anatomy and lymph node drainage in upper extremities are not consistently symmetric between individuals. Handedness does not correlate with lymphatic symmetry, challenging historical assumptions.
Area of Science:
- Anatomy and physiology of the lymphatic system.
- Medical imaging techniques for lymphatic assessment.
Background:
- Historical assumption of left-right lymphatic symmetry in individuals.
- Lack of validation for assumed lymphatic symmetry in clinical practice and research.
Purpose of the Study:
- Evaluate symmetry of superficial lymphatic anatomy and lymph node drainage in healthy female upper extremities.
- Determine if handedness influences lymphatic symmetry.
Main Methods:
- Bilateral indocyanine green (ICG) lymphography and lymphoscintigraphy in 36 healthy female volunteers.
- Mapping of eight collecting vessel pathways and visualization of 13 lymph node groups.
- Assessment of hand dominance via hand grip strength.
Main Results:
- Only 28% of participants showed symmetric lymphatic pathways (ICG).
- Complete symmetry of lymph node groups was observed in only 3% of participants.
- Symmetric lymphatic channels on ICG were more frequent in dominant-handed individuals (39%) versus non-dominant (17%), though not statistically significant.
Conclusions:
- Upper extremity lymphatic anatomy and functional drainage exhibit significant asymmetry.
- Lymph node drainage shows less symmetry than lymphatic channels.
- Symmetric lymphatic anatomy is not associated with hand dominance, refuting the prevailing assumption.
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