Perforating and deep lymphatic vessels in the knee region: an anatomical study and clinical implications.
BACKGROUND
To determine the relationship between the perforating and deep lymphatic vessels in the knee region for clinical implications.


METHODS
Four lower limbs from two unembalmed human cadavers were used. Under a surgical microscope, 6% hydrogen peroxide was employed to detect lymph vessels accompanying the small saphenous vein, anterior tibial, posterior tibial and fibular blood vessels all commencing from distal ends of specimens. Each lymphatic vessel was inserted by a 30-gauge needle and injected with a barium sulphate mixture. Each specimen was dissected, radiographed and photographed to determine the perforating and deep lymphatic vessels in the region.


RESULTS
A perforating lymph vessel was observed in the popliteal fossa of each specimen. It arose from the superficial popliteal lymph node and terminated in the deep popliteal lymph node. The anterior tibial, posterior tibial and peroneal lymph vessels were discovered in the region travelling with the corresponding vascular bundles. After penetrating the vascular aperture of the interosseous membrane between the tibia and fibula, the anterior tibial lymph vessel entered directly into the deep popliteal lymph node or converged to either the posterior tibial or fibular lymph vessel, before entering the node. The posterior tibial and peroneal lymph vessels entered the deep popliteal lymph node. The efferent lymph vessel of the deep popliteal lymph node travelled with the femoral vascular bundle.


CONCLUSIONS
The perforating and deep lymphatic vessels in the knee region has been presented and discussed. The information advances our anatomical knowledge and the results will benefit clinical management.
Department of Anatomy, College of Biomedical Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Wei-Ren
WR
Pan
Department of Anatomy, College of Biomedical Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Fan-Qiang
FQ
Zeng
Department of Anatomy, College of Biomedical Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China.
De-Guang
DG
Wang
Department of Radiology, Xuzhou Oriental People's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Zhi-Qiang
ZQ
Qiu
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D005360:Fibula / Q000033:anatomy & histology; D006801:Humans; D007717:Knee / Q000033:anatomy & histology*; D035002:Lower Extremity / Q000033:anatomy & histology* / Q000098:blood supply / Q000000981:diagnostic imaging; D008198:Lymph Nodes / Q000033:anatomy & histology; D008208:Lymphatic System / Q000033:anatomy & histology*; D042601:Lymphatic Vessels / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000648:ultrastructure; D008297:Male; D010781:Photography / Q000379:methods; D011859:Radiography; D013977:Tibia / Q000033:anatomy & histology; D016707:Tissue Fixation / Q000379:methods
deep lymph vessel; knee; metastases; perforating lymph vessel; popliteal lymph node