open access

Ahead of Print
Original article
Submitted: 2021-05-29
Accepted: 2021-09-14
Published online: 2021-09-28
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Superficial lymphatic drainage of the vulva and its relation to the regional nodes: An experimental study

D. Pavlista1, O. Eliska1
DOI: 10.5603/FM.a2021.0096
·
Pubmed: 34590298
Affiliations
  1. First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic, Apolinarska 18, 12802 Prague, Czech Republic

open access

Ahead of Print
ORIGINAL ARTICLES
Submitted: 2021-05-29
Accepted: 2021-09-14
Published online: 2021-09-28

Abstract

Background: Sentinel node biopsy in vulvar cancer  is associated with much less morbidity than inguinofemoral node dissection. Our study focused on describing the morphology of superficial lymphatic drainage of the vulva and its relationship to regional nodes, which may facilitate orientation during surgery.

Materials and methods: In 24 female cadavers, injections of patent blue (at various localizations mediallyunilaterally and bilaterally) were used to visualize the lymphatic drainage of the vulva. After dissection of lymphatic vessels and nodes, their course was documented by photograph and then analyzed. Subsequently, a map of vulvar superficial lymphatics was created.

Results: The cutaneous and subcutaneous tissue of the vulva primarily drained to superficial inguinal nodes. There was no evidence of a solitary lymph node that drained the unilateral vulva. Each area of the vulva drained to its own lymph node, which was variably localized in the subcutaneous groin around the great saphenous vein. Anastomoses between individual inguinal superficial lymph nodes are likely. Right-left symmetry in the course of lymphatic collectors was not detected. Natural drainage of the medial and paramedial   areas to contralateral inguinal nodes was also not detected. The drainage pattern to ipsilateral inguinal nodes was consistent in cadavers without evidence of vulvar disease and may be applicable in the early stages of vulvar cancer.

Conclusions: There was no evidence of a solitary node that drained the unilateral vulva. Each part of the vulva may drain to a corresponding lymph node in a different localization of the groin. The surgeon should take this variability into account.

Abstract

Background: Sentinel node biopsy in vulvar cancer  is associated with much less morbidity than inguinofemoral node dissection. Our study focused on describing the morphology of superficial lymphatic drainage of the vulva and its relationship to regional nodes, which may facilitate orientation during surgery.

Materials and methods: In 24 female cadavers, injections of patent blue (at various localizations mediallyunilaterally and bilaterally) were used to visualize the lymphatic drainage of the vulva. After dissection of lymphatic vessels and nodes, their course was documented by photograph and then analyzed. Subsequently, a map of vulvar superficial lymphatics was created.

Results: The cutaneous and subcutaneous tissue of the vulva primarily drained to superficial inguinal nodes. There was no evidence of a solitary lymph node that drained the unilateral vulva. Each area of the vulva drained to its own lymph node, which was variably localized in the subcutaneous groin around the great saphenous vein. Anastomoses between individual inguinal superficial lymph nodes are likely. Right-left symmetry in the course of lymphatic collectors was not detected. Natural drainage of the medial and paramedial   areas to contralateral inguinal nodes was also not detected. The drainage pattern to ipsilateral inguinal nodes was consistent in cadavers without evidence of vulvar disease and may be applicable in the early stages of vulvar cancer.

Conclusions: There was no evidence of a solitary node that drained the unilateral vulva. Each part of the vulva may drain to a corresponding lymph node in a different localization of the groin. The surgeon should take this variability into account.

Get Citation

Keywords

vulva, cancer, sentinel node, lymphatic mapping, anatomy

About this article
Title

Superficial lymphatic drainage of the vulva and its relation to the regional nodes: An experimental study

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Original article

Published online

2021-09-28

DOI

10.5603/FM.a2021.0096

Pubmed

34590298

Keywords

vulva
cancer
sentinel node
lymphatic mapping
anatomy

Authors

D. Pavlista
O. Eliska

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