It is a power point presentation by Dr Zobayer Mahmud Khan while he was taking a lecture class of this topic in Sir Salimullah Medical College, Mitford, Dhaka. Here the venous drainage and the lymphatic drainage are stated clearly with many of the clinical events. Hope you can learn from here. Photographs used here are collected from The "Essential of human Anatomy (inferior extremity) by A.K. Datta".

1. Venous drainage,
Lymphatic drainage
of the lower limbs
Dr Zobayer Mahmud Khan
MS Anatomy

2. 3

3. Superficial veins
Deep veins
Perforating veins

4. Superficial veins
Small saphenous
Great saphenous
Superficial fascia

5. Deep fascia
Deep veins
Accompany the arteries
Below knee- Venae comitantes
Above knee- Single major vein

7. Perforating
veins
Communicate superficial with deep veins
by piercing the deep fascia

10. Special features of lower limb veins
All veins of the lower limb are
provided with valve to direct
the blood to the heart
Valves are numerous in
the deep veins than in
the superficial veins
The veins from the muscles drained in
the deep veins are valved except
soleus where they are arranged in the
form of venous sinus.

11. In upright position
Contraction of the calf muscle (calf pump)
which acts as a peripheral heart within the
tight sleeve of deep fascia squeezes the blood
upwards along the deep veins.
Transmitted pulsation by the adjacent arteries
Arrangements of valve in the veins
In recumbent position
The vis-a-tergo flow produced by the
contraction of the heart
The suction action of the diaphragm
Factors help in venous return

12. In upright position, the venous return from the lower limb
against gravity depends largely on the contraction of calf
muscles. Therefore, these muscles are termed calf pump.
The soleus muscle contains venous sinuses filled with
blood. When soleus muscle contracts, it pumps the blood
from its large venous sinuses into the deep veins, and
when it is relaxed it sucks the blood from the superficial
veins. The unidirectional blood flow is maintained by the
valves in the perforating veins. Hence, the soleus is
sometimes termed peripheral heart.
The soleal sinuses are common site for thrombosis and
source of pulmonary embolism in sedentary individuals.
Calf pump and peripheral heart

13. Medial end of the dorsal venous
arch of the foot supplemented
by the medial marginal vein
Passes upward 1 inch in front of
the tibial malleolus
Crosses obliquely the medial
surface and reaches the knee
Runs upward along the medial side
of the thigh to reach the
saphenous opening (fossa ovalis)
Passes through the saphenous opening
after piercing the cribriform fascia
Finally drains into the femoral vein
after piercing the femoral sheath
Great saphenous vein

14. Just below the knee
Posterior arch vein
Anterior leg vein
Antero-lateral vein
Postero-medial vein
Just before piercing the
cribriform fascia
Superficial epigastric vein
Superficial circumflex iliac vein
Superficial external pudendal vein
Tributeries

15. Adductor canal perforator
(mid hunter’s perforator)
Great saphenous+femoral vein at Hunter’s canal
Knee perforators
Great ssaphenous+posterior tibial vein
Medial ankle perforators (3)
Great saphenous+posterior tibial vein
Lateral ankle perforator (1)
Small (Short) saphenous+posterior tibial vein
Perforating veins

16. In coronary by-pass operation to relieve
the ischemia of the heart, a segment of
great saphenous vein is removed and
used for aorto-coronary grafting to bypass
an arterial obstruction.
Due to the presence of valves, the vein
has to be reversed so that its valves do
not obstruct the blood flow.
Great saphenous vein graft

17. Done in the saphenous vein in emergencies
Usually made at the ankle
Saphenous nerve lies in front of the vein.
Hence, during cut-down procedure, the nerve
should be recognized to avoid its injury.
Venesection

18. 10 to 20 valves
One valves lies just before it pierces the cribriform fascia
One is located at its junction with the femoral vein
Valves in the great saphenous vein

19. In 80% people, external iliac vein
presents a valve which protects
the sapheno-femoral junction
against high blood pressure.
20% people possesses no such
valve and becomes victim of
varicose vein commencing from
the sapheno-femoral junction and
extending gradually downward.
Functional importance of
Sapheno-femoral valve

20. Superficial veins of the lower limb are often
dilated and tortuous, and become varicose.
Over the area of varicosity the skin become
pigmented and suffers from lack of nutrition
which leads to varicose ulcer.
Varicose vein

21. Incompetency of valves in perforating veins,
or superficial veins or both
Persistent elevation of intra-abdominal pressure
due to abdominal tumours or multiple pregnancies
Thrombosis of the deep veins
Varicose vein

22. Varicose vein

23. Continuation of the lateral
end of the dorsal venous
arch supplemented by lateral
marginal vein of the foot
below and behind the lateral
malleolus
Ascends and run along the
middle of the back of the leg
Pierces the deep fascia and
undergoes a subfascial course
Comes in the middle of
the popliteal space
Dips sharply to terminate
into the popliteal vein
Small (short)
saphenous vein

24. Superficial
Deep
Inguinal lymph node

25. Superficial lymph node
Lower group (vertical)
Upper group (horizontal)
Lateral member
Medial member

26. Lateral member receive lymph from
The gluteal region
Adjoining anterior abdominal wall
below the umbilicus
Upper group (horizontal)

27. Medial member receive lymph from
The subcutaneous tissue of the anterior
abdominal wall below the umbilicus
Penis including prepuce and scrotum in male
Vulva and vagina below the hymen in female
Perinium and lower part of the anal canal
below the pectinate line
A few uterine lymphatics which accompany
the round ligament of uterus
Upper group (horizontal)

28. Lymphatics of testes do not
drain into the inguinal lymph node.
Upper group (horizontal)

29. Four or five in number
Accompany the lateral side of the
termination of the great saphenous vein
It receive afferent from all superficial
lymph vessels of lower limb, except the
vessels that follow the small saphenous
vein which end in the popliteal nodes
Lower group (vertical)

30. Efferent vessels from all superficial lymph
nodes drain into the external iliac nodes

31. Vary from one to three in number
Lie on the medial side of the femoral vein
The lowest one is situated below the junction of
the great saphenous vein and femoral vein
The middle in the femoral canal (gland of Cloquet)
The highest in the lateral part of the femoral ring
within the femoral septum
Deep inguinal lymph nodes

32. Deep inguinal lymph nodes

33. Afferent vessels received lymph from
Deep lymph nodes which
accompany the femoral vessels
Glans penis or glans clitoris
A few efferent vessels from the
superficial inguinal nodes
Deep inguinal lymph nodes

34. Efferent from the deep nodes drain
into the external iliac lymph node

35. Elephantiasis