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Foundations Of Manual Lymph Drainage (Third Edi...



Sentinel lymph node biopsy is fundamental in the staging of primary cutaneous melanoma (PCL), but reported lymphoscintigraphic patterns are very heterogeneous. In this systematic review, we evaluated the role of the popliteal station in below-knee PCL. A systematic search of literature through was conducted on the electronic databases PubMed, SCOPUS, and Web of Science (WOS) to identify eligible studies. A total of 22 studies (n=5673 patients) were included. During the analysis of the included articles, it was not possible to classify patients into the 3 Menes popliteal drainage pattern, obtained by lymphoscintigraphy. The analysis of lymphatic drainage in patients undergoing lymphoscintigraphy for melanoma of the lower extremities below the knee was reported in 5637 patients and the type of lymphatic popliteal drainage was reported only in 5.64% (320 patients). The rate of popliteal lymph nodes melanoma metastases was 1.49%: they were located exclusively at the popliteal level in 0.60%, at the popliteal and inguinal levels in 0.39%, at the popliteal and iliac level in 0.02%, and at the groin level in 0.48%. In conclusion, the most common lymphoscintigraphic pattern is represented by popliteal nodes in-transit or interval nodes, so metastases from below-knee melanomas commonly transit through popliteal nodes stations and arrive to inguinal nodes stations. The popliteal nodes are the primary station in about 5.64% of cases. Larger studies are needed to corroborate these findings.




Foundations of Manual Lymph Drainage (Third Edi...



Sentinel lymph node biopsy (SLNB) represents a fundamental step in the staging and prognosis of patients with primary cutaneous melanoma (PCN) [1]. It is defined as the lymph node that first drains the lymph of a specific area of skin and is based on Halsted theory of stepwise dissemination of tumor cells from peritumoral lymphatics to the sentinel lymph node (SLN), and then to more distant lymph nodes. The candidates of SLNB are those with thick melanomas (Breslow thickness cut-off of 0.75 mm and 1 mm as per the National Comprehensive Cancer Network (NCCN) [2], and American Joint Committee on Cancer (AJCC) respectively) [3], or thinner melanoma in the presence of ulceration, high mitotic rate, and/or lymphovascular invasion [2]. The identification of these lymph nodes is performed via injection of tracers into the peritumoral site [3, 4]. The current guidelines, according to the AJCC 8th edition [3] and the guidelines of the Italian Association of Medical Oncologists (AIOM) [5], changed the recommendation for SLN-positive cases. Although in the previous guidelines, these patients were managed with completion lymph node dissection (CLND), presently SLN positivity is not a mandatory indication for a CLND but lymph node dissection currently is indicated in macroscopic nodal disease (Stage IIIB+). Lymphatic drainage for most anatomical areas is variable, but it appears to be more predictable in the lower limbs (below-knee) [6], in which traditionally two main drainage routes are recognized:


The primary outcome was the type of popliteal node drainage in patients undergoing lymphoscintigraphy for melanoma of the lower limbs below the knee (as per the classification by Menes et al.) [7]. The secondary outcomes were the melanoma metastasis rate in patients with positive popliteal sentinel node, the type of popliteal lymphadenectomy, the type of surgical access technique at popliteal fossa, the overall survival (OS), and the disease-free survival (DFS).


The analysis of lymphatic drainage in patients undergoing lymphoscintigraphy for melanoma of the lower extremities below the knee was reported in 5,637 patients and the lymphatic popliteal drainage was reported only in 5.64% (320 patients).


In patients with popliteal sentinel node, the rate of CLND (complete lymph node dissection) was 13.43% (43/320 patients with popliteal drainage). Exclusively popliteal CLND rate was 60.47% (26 patients), while popliteal and inguinal CLND rate was 37.21% (16 patients), and the popliteal and iliac CLND rate was 2.326% (1 patient).


Metastasis of melanoma to popliteal nodes is a rare pathological condition. The lymphatic drainage of melanomas to the popliteal fossa is uncommon and few cases have been described in the literature [36]. For these reasons, some physicians do not perform the examination of the popliteal region during clinical examination and during lymphoscintigraphy in patients with melanoma of the leg [36]. In contrast, popliteal lymph nodes are the first station for the lymphatic drain of squamous carcinomas and sarcomas below the knee [37,38,39].


The classic Human Anatomy textbooks describe the popliteal lymph nodes as fundamental passage station in the lymphatic drainage of the leg and foot [40]. These nodes are located in the adipose tissue of the popliteal fossa (Fig. 4) near the popliteal vessels (Fig. 5) [41,42,43].


This is the first systematic review of the literature in which the role of popliteal lymph nodes in lymphatic drainage of the leg and foot in patients with melanoma has been assessed. The current review documents that melanoma of distal legs (below the knee) is more frequently observed in patients in the fifth or sixth decade of life, with a higher incidence in women and it is associated with a higher Breslow thickness (average 2.86 mm). From the analysis of lymphoscintigraphy of the lower limbs performed for melanoma located below the knee, results different from those reported in the classic scientific literature emerge. These different types of lymphatic drainage were originally classified by Menes et al. [7] into 3 different patterns as obtained by lymphoscintigraphy in patients with a sentinel node-positive biopsy. This systematic review of the literature evaluated the role of the popliteal lymph nodes with respect to the different lymphoscintigraphic patterns of the leg and foot.


In these patients, the classification of Menes represents a promising potential challenge that should be better investigated, but it is not clearly validated, according to the too small number of patients having described this popliteal drainage pattern, as presented by Menes [7]. In our systematic review, it was not possible to rank patients into the 3 Menes drainage pattern classification without reviewing the lymphoscintigraphic images of each patient.


Manual Lymph Drainage (MLD) is today an indispensable part of Physical Therapy. This compendium begins by explaining the anatomical and physiological foundations of MLD. Simple, clear diagrams show the lymph pathways, and readers will be brought up to date with more current perspectives on the lymph systems.


If you experience lymphedema after a mastectomy, which involves the removal of breast tissue to treat or prevent breast cancer, lymph drainage massage can help ease mild to moderate symptoms post-surgery.


Lymph drainage massage is a useful technique in treating lymphedema and other health conditions. If you have symptoms of trapped lymph fluid in the body, talk to your doctor about the benefits of this type of massage.


Written by the world's leading authorities on Dr. Emil Vodder's techniques for manual lymph drainage (MLD), this lavishly illustrated guide provides step-by-step descriptions of how to massage the lymph vessels to stimulate smooth lymphatic flow.


This engaging 5 day MLD Certification course is based on the techniques developed by Dr. Emil Vodder, Ph.D., MT. When skillfully applied, this therapeutic form of soft-tissue mobilization dramatically enhances lymph formation and promotes drainage within the superficial and deep systems of the lymph vascular network. MLD effectively reduces traumatic and post-surgical edema, and can provide symptomatic relief of migraine headaches, fibromyalgia, rheumatoid arthritis, scleroderma, reflex sympathetic dystrophy (RSD), stress, fatigue, and more. MLD also induces general relaxation and detoxification.


The lymphatic system is the most important and frequent route of metastasis. Usually the ipsilateral cervical lymph nodes are the primary site for metastatic deposits, but occasionally contralateral or bilateral metastatic deposits are detected. The risk for lymphatic spread is greater for posterior lesions of the oral cavity, possibly because of delayed diagnosis or increased lymphatic drainage at those sites, or both. Cervical lymph nodes with metastatic deposits are firm-to-hard, nontender enlargements. Once the tumor cells perforate the nodal capsule and invade the surrounding tissue, these lymph nodes become fixed and non mobile.


The study of lymphatic drainage of various organs is important in the diagnosis, prognosis, and treatment of cancer. The lymphatic system, because of its closeness to many tissues of the body, is responsible for carrying cancerous cells between the various parts of the body in a process called metastasis. The intervening lymph nodes can trap the cancer cells. If they are not successful in destroying the cancer cells the nodes may become sites of secondary tumours.


Lymphedema can also occur after surgical removal of lymph nodes in the armpit (causing the arm to swell due to poor lymphatic drainage) or groin (causing swelling of the leg). Conventional treatment is by manual lymphatic drainage and compression garments. Two drugs for the treatment of lymphedema are in clinical trials: Lymfactin[39] and Ubenimex/Bestatin. There is no evidence to suggest that the effects of manual lymphatic drainage are permanent.[40]


The lymphatic system plays an essential role in systemic immunity, fluid homeostasis, and returning tissue fluid and macromolecules to the circulation. Lymphatic drainage plays a significant role in the pathology and treatment of breast cancer; globally the most frequently diagnosed malignancy and leading cause of death due to cancer in women.


Most (75-90%) of the lymphatic drainage of the breast is to the ipsilateral (same side) axillary nodes. Nearly all lymphatics of the breast drain along a subdermal plane into the axillae, typically collecting in a single sentinel lymph node at the lateral border of the pectoralis major muscle. 041b061a72


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