title: Alternative lymphatic drainage routes from the lateral heel to the  inguinal lymph nodes: anatomic study and clinical implications.
abstract: BACKGROUND
  The route of lymphatic drainage from the heel to the inguinal lymph nodes is required to be accurately evaluated for clinical needs.
  
  
  METHODS
  Seven lower limbs from four unembalmed human cadavers were studied. Under a surgical microscope, 6% hydrogen peroxide was used to detect the lymphatic vessel on the lateral side of the heel. The vessel was then injected with a radio-opaque lead oxide mixture. The vessel was traced, photographed and radiographed to demonstrate the lymphatic pathways from the lateral heel to the inguinal lymph nodes. The final results were transferred to the computer for image analysis.
  
  
  RESULTS
  The lymph collecting vessel arising from the skin of the fossa between the lateral malleolus and the Achilles tendon ran along the posterolateral side of the leg, deep to the superficial fascia. From the popliteal fossa to the inguinal lymph nodes, three lymphatic routes were found: (i) via the superficial tissue of the medial side of the thigh; (ii) running with the superficial femoral blood vessels; (iii) running between the sciatic nerve and the profunda femoral vessels. The number and type of lymph nodes found in the popliteal fossa and femoral triangle were different from person to person.
  
  
  CONCLUSIONS
  Actual and accurate lymphatic routes from the skin above the posterolateral heel to the inguinal lymph nodes have been described. This information upgrades our anatomical knowledge and the results will be of benefit for the clinical management of trauma and malignancies in the lower limb.
authors.affiliation: The Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne, Melbourne, Victoria, Australia. w.pan@unimelb.edu.au
authors.forename: Wei-Ren
authors.initials: WR
authors.lastname: Pan
authors.forename: Cara Michelle
authors.initials: CM
authors.lastname: le Roux
authors.forename: Sidney M
authors.initials: SM
authors.lastname: Levy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007264:Inguinal Canal; D007866:Leg / Q000033:anatomy & histology; D008198:Lymph Nodes / Q000033:anatomy & histology*; D042601:Lymphatic Vessels / Q000033:anatomy & histology*; D008220:Lymphography; D008297:Male; D008953:Models, Anatomic