title: The distribution of lymph nodes and their nutrient vessels in the groin region: an anatomic study for design of the lymph node flap.
abstract: BACKGROUND
  The groin lymph node flap transfer has been used for treatment of extremity lymphedema. The design of this flap is based on the superficial circumflex iliac artery/vein (SCIA/V), or superficial inferior epigastric artery/vein (SIEA/V). The purpose of this study is to delineate the distribution of lymph nodes in the groin area and their relationship to inguinal vessels by the use of multidirector-row CT angiography (MDCTA).
  
  
  METHODS
  MDCTA was performed in 52 patients who underwent the deep inferior epigastric perforator (DIEP) flap or transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction. The MDCTA data were used to analyze the locations of lymph nodes and their adjacent vascular vessels. The groin region was divided into the superior lateral (I), superior medial (II), inferior lateral (III), and inferior medial (IV) quadrants based on the point where SCIV joined into great saphenous vein. The number of lymph nodes in each of the four quadrants was counted and the dominant vessels were observed.
  
  
  RESULTS
  The mean number of lymph nodes in quadrants I-IV were 3.3 ± 1.6, 2.0 ± 1.2, 1.5 ± 1.3, and 1.9 ± 1.4, respectively. The difference between the four quadrants was statistically significant (P < 0.001). In quadrant I, the appearance rate of SCIA was 100% while SIEA was 6.6%. In quadrant II, no SCIA was observed but the appearance rate of SIEA was 78.0%. There were neither SCIA nor SIEA observed in quadrants III and IV.
  
  
  CONCLUSIONS
  The superior lateral quadrant of the groin region was found to have the most lymph nodes. The superficial circumflex iliac vessels are the major sources for blood supply to this region. The findings from this study provide evidence for the clinical design of the lymph node flap from the groin area.
authors.affiliation: Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Han
authors.initials: H
authors.lastname: Zhang
authors.forename: Weiwei
authors.initials: W
authors.lastname: Chen
authors.forename: Lan
authors.initials: L
authors.lastname: Mu
authors.forename: Ru
authors.initials: R
authors.lastname: Chen
authors.forename: Jie
authors.initials: J
authors.lastname: Luan
authors.forename: Dali
authors.initials: D
authors.lastname: Mu
authors.forename: Chunjun
authors.initials: C
authors.lastname: Liu
authors.forename: Minqiang
authors.initials: M
authors.lastname: Xin
mesh_terms: D006119:Groin / Q000033:anatomy & histology* / Q000098:blood supply; D006801:Humans; D008198:Lymph Nodes / Q000033:anatomy & histology* / Q000098:blood supply; D008209:Lymphedema / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*