Inguinal lymph nodes drain?….
- skin of external genitalia
- skin of buttocks and abdomen
- skin and deeper tissues of the dorsum of foot snd the leg
Popliteal lymph nodes drain….
- plantar surface of the foot
- posterior calf
Pelvic and sacroiliac lymph nodes drain…
Sacroiliac
- sciatic pathway
- anus and rectum
Pelvic (iliac)
- urogenital organs
- uterus
- vagina
- urethra
- ureters
- bladder
- lower colon
Alternate pathway of pelvic and sciatic nodes
Sciatic pathway. Not everyone has in bypass inguinal nodes
Abdominal nodes drain…
- stomach
- duodenum
- pancreas
- spleen
- liver - concave surface
- gall bladder
Lumbar nodes and trucks drain…
- ovaries
- testes
- kidneys and adrenals
- lymph from abdominal nodes
Cysterna chyli collects lymph from…
Right and left lumbar trunks and intestinal truck and legs
Thoracic organs are drained by…
Heart - via mediastinal nodes and right bronco-mediastinal trunk
Lung - vessels from lower left lobe follow left bronchus, via hilar lymph nodes crossing at the carina and joining right broncho- mediastinal trunk
Axillary nodes drain…
- arm
- mammary gland
- skin of thorax
Drainage of the breast…
- supraclavicular
- internal mammary nodes
Sentinel node biopsy
Most drainage is to the axilla
- central breast - 100%
- lateral quadrants - 95%
- medial quadrants - 88%
- some retrosternal drainage - 10-50%
Parasternal nodes drain…
- mammary gland medial aspect
- intercostal spaces - ribs 1-9 anterior (attached to sternum)
Paraspinal nodes drain….
- posterior intercostal pathways - ribs 1-13
Lateral to medial to spine
Not skin drainage b/w ribs
Thoracic duct drains…
- left lung
- left cervical nodes
- lungs - upper left
- left parasternal nodes
- para spinal nodes - posterior intercostals
- abdominal and pelvic nodes - inguinal and popliteal nodes
Right lymphatic duct drains…
- right axillary nodes
- right cervical nodes
- heart
- lungs - all right lobes and lower left
- liver - convex surface
- right parasternal nodes
Brain and spinal cord drains…
- no lymph vessels in the CNS
- sub arachnoid sheath
- suboccipital LN
- perineurim
- walls of arteries and veins
Brain and spinal cords drain…
- 40% olfactory, optic and auditory nerves
- 60%
- epidural LV
- virchow- robin spaces
- vasa vasorum
- vasa lympho vasorum
- subarachnoid sheath of spinal nerves
What are the principles of applying MLD?
Clear proximal pathways first
Follow drainage pathways
Long duration - at least 20 mins
Move the skin - no gliding
Stretch skin in 2 directions.
Prescribed pressure - up to 30mmHg
Variable pressure phase - zero phase
Slow and relaxing - aids sympathicolytic effects
Repetitive
Rhythmic
No pain. No hyperaemia
What are three absolute contraindications of MLD?
Acute inflammation with infection
Untreated thrombus
Untreated cancer
Congestive heart failure
What are the relative contraindications of MLD?
Chronic inflammation
Treated thrombus - know high risk groups
Treated cancer - know current status and treatment received
Asthma- omit sternum and short treatment times.
Hyperthyroid - untreated
Pregnancy - no deep abdominal, complications
Menstruation - omit abs if painful
Mole changes
History of tuberculosis
Hypotension - short treatment times
