Changes in the lymph structure of the upper limb after axillary dissection: Radiographic and anatomical study in a human cadaver

Background: There have been very few anatomical reports on the changing lymph structure of the upper limb after axillary dissection despite its clinical significance for predicting skin cancer recurrence in the limb and secondary lymphedema. The authors used both upper limbs harvested from a fresh human cadaver that had undergone unilateral right radical mastectomy and radical axillary dissection for breast cancer. Methods: Hydrogen peroxide was used to identify and inflate the lymphatic vessels. Individual channels were injected with a radiopaque lead oxide mixture and recorded on x-ray film. Results: Results from the normal left upper limb were similar to results from the authors' previous studies. However, the right limb from the mastectomy side showed remarkable differences and revealed that the lymph node clearance in the axilla had been incomplete on that side. The major difference was the almost complete absence of the superficial lymphatic network in the right arm, proximal to the elbow, because of fibrosis and blockage of the lymphatic channels. A circuitous pathway was identified that bypassed the blocked lymphatics in the arm to reach the deep system. This was facilitated often by backflow through precollectors and avalvular lymph capillaries in the dermis of the forearm, to reach eventually the few remaining lymph nodes in the axilla. Conclusions: Previously undetected lymph channels connecting the superficial and the deep lymphatic system had opened up because of the blockage of superficial lymphatic vessels caused by axillary dissection. It is presumed that these channels prevented lymphedema in this case.