title: Understanding the three-dimensional anatomy of the superficial lymphatics of the limbs.
abstract: BACKGROUND
  There are minimal data in the current literature regarding the depth of the superficial lymphatic collectors of the limbs in relation to the various subcutaneous tissue layers.
  
  
  METHODS
  Injection, microdissection, radiographic, and histologic studies of the superficial lymphatics and the subcutaneous tissues of 32 limbs from 15 human cadavers were performed.
  
  
  RESULTS
  Five layers were consistently identified in the integument of all the upper and lower limb specimens: (1) skin, (2) subcutaneous fat, (3) superficial fascia, (4) loose areolar tissue, and (5) deep fascia. Layer 2 was further divided into superficial (2a) and deep (2c) compartments by a thin, transparent, horizontal septum (layer 2b). The main superficial veins and the superficial nerves coursed in layer 4. The lymphatic collectors were found at layer 2c and layer 4.
  
  
  CONCLUSIONS
  The use of consistent nomenclature to describe the subcutaneous tissue layers facilitates a greater understanding and discussion of the anatomy. In lymphovenous anastomosis for the treatment of lymphedema, indocyanine green lymphography is an unreliable method for identification of the superficial collectors of the thigh. The medial proximal leg, the dorsum of the wrist over the anatomical snuffbox, and the volar proximal forearm provide suitable areas for locating superficial collectors with nearby matching size veins. In vertical medial thigh lift, choosing a dissection plane superficial to the great saphenous vein is unlikely to preserve the collectors of the ventromedial bundle.
authors.affiliation: Parkville, Victoria, Australia From Anatomy and Neuroscience, University of Melbourne.
authors.forename: Saam S
authors.initials: SS
authors.lastname: Tourani
authors.forename: G Ian
authors.initials: GI
authors.lastname: Taylor
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ashton
mesh_terms: D000328:Adult; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007208:Indocyanine Green; D035002:Lower Extremity / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008208:Lymphatic System / Q000033:anatomy & histology; D042601:Lymphatic Vessels / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D008297:Male; D042282:Microdissection / Q000379:methods*; D011859:Radiography; D012501:Saphenous Vein / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D034941:Upper Extremity / Q000033:anatomy & histology / Q000000981:diagnostic imaging
chemical_list: D007208:Indocyanine Green