Anatomy of the lymphatic system and structural changes in lymphedema of the extremities

A better understanding of normal lymphatic anatomy and how it changes in lymphoedema is crucially important in planning effective surgical interventions. The seminal works of the lymphatic anatomy were published by notable anatomists in the early twentieth century, but their focus was limited to the normal condition. However, the development of clinical imaging techniques since then has enabled us to investigate anatomical changes in the lymphatics that arise in patients with lymphedema. The lymphatics are structured in two layers, comprising superficial and deep systems separated by the deep fascia. The superficial lymphatic system is particularly significant for understanding the pathology of lymphedema. This chapter describes both the normal anatomy of the superficial lymphatic system in the extremities and also how it alters in lymphedema.