Venous lymphatic drainage of lower limb

1. Major Rahul Jha
Graded Specialist (Anatomy)
ACMS

2. Sequence
• Veins of the lower limb.
• Lymphatic drainage of the lower limb.
• Applied

3. Veins of the lower limb
• Of immense clinical and surgical importance.
• Venous drainage against gravity.
• Factors which help in venous drainage:-
– Calf muscles.
– Transmitted pulsation from arteries.
– Presence of valves in perforators & deep veins.
– Negative intrathoracic pressure.

5. Veins of the lower limb
• Great Saphenous vein (Greek – easily
seen).
• Longest vein of the body & represents
pre-axial vein.
• Course.

6. COMENCEMENT
& COURSE OF GR
SAPH VN

8. • Tributaries:-
– At the commencement-
• Medial marginal vein
(formative).
– In the leg:-
• Posterior arch vein.
– Just below knee:-
• Anterior leg veins.
– In the thigh:-
• Anterolateral vein.
• Posteromedial vein.
• Tributaries:-
– Just before piercing the
cribriform fascia.
• Branches of femoral
artery.
– Just before termination:-
• Deep external pudendal.
Veins of the lower limb

10. Short Saphenous vein
• Formed by
union of
lateral end
of dorsal
venous arch
& lateral
marginal
vein of foot.

11. Perforators -Direct

12. Perforators - Indirect

13. Veins of the lower limb
• Perforators:-
– Mid-hunter perforator – connects great
Saphenous vein with femoral vein.
– Knee perforators – Connects great saphenous with
posterior tibial vein.
– Three medial ankle perforators.
– One lateral ankle perforator.

14. Applied anatomy – Varicose veins
• Aetiology –
– Valve at the Ext Iliac vein
absence in 20%.
• In elevated intra-
abdominal pressure.
• Incompetency of the
valves

15. Tourniquet Test
• Procedure.
• Results – 30 secs.
– If varicosities remain empty in 30 secs –
communicating veins below tubing competent.
– If fill up – veins incompetent.
– If varicosities fill up with tubing in place – SF jn
incompetent.
– Fill up > - Incompetency of SF jn & vein below.

16. Perthes’ test
• Tourniquet applied at the thigh.
• Patient walks for 5 mins.
• If fullnes disappears – valves are competent.
• If fullness increases – valves incompetent.

17. • And also used for
coronary by-pass
operations to relieve
ischemia of the heart.
• But presence of
valves??
Applied anatomy

18. LYMPHATIC DRAINAGE OF LOWER
LIMB

20. Lymphatic drainage of the lower limb
• Superficial group of
lymphatics.
• Deep group of
lymphatics.
• Popliteal lymph nodes.
• Testis being drained by
Para – aortic group of
lymph nodes.

21. Lymph nodes
• Superficial group :-
– Horizontal group –
• Medial –
– Genitals incl penis, prepuce , scrotum in male; Vulva, vagina in
female.
– Perineum & lower part of anal canal below the pectinate line.
– Few uterine lymphatics.
– Testis not drained.
• Lateral –
– Gluteal region.
– Abdominal wall below the umbilicus.

22. • Vertical set:-
– Accompanies the lateral side of the great
saphenous vein.
– Darin the area of lower limb except the postero
lateral aspect of leg, sole & foot.
• Deep nodes:-
– Lie on the medial side of femoral vein.
– Afferents – Glans penis/clitoris.
Lymph nodes