THE LYMPH XODE8 OF THE LOWER EXTREMITY 



787 



nodes. In the forearm there are about thirty vessels, in the middle of the arm 

 there are from fifteen to eighteen (Sappey). 



The deep lymphatic vessels of the uppev extremity convey the lymph from 

 h'>ne, periosteum, muscle, ligament, etc. They pass up the limb with the chief 

 vessels, there usually being two trunks to each artery. In the arm there are 

 two or three vessels. Some few 

 vessels terminate in the small nodes 

 along the radial, ulnar, and brach- 

 ial arteries, but most of them pass 

 directly to the axillary nodes. 



Applied Anatomy. In malignant 



d'wases, or other affections implicating 



the upper part of the back and shoulder, 



the front of the thorax and mammae, the 



upper part of the front and side of the 



abdomen, or the hand, forearm, or arm, 



the axillary nodes are liable to be found 



enlarged. 



In secondary tti/philix the supratroch- 



h-ar node is found to be enlarged. This 



node is subcutaneous and readily palpa- 

 ble against the subjacent bone when 



enlarged. Normal axillary nodes cannot 



be palpated. The axilla is a passage- 

 way for structures between the neck or 



thorax and the upper extremity, and 



purulent collections or tumors may extend 



from the neck or thorax into the axilla or 



from the axilla into the neck or thorax. 

 The axillary nodes are involved early 



in cases of cancer of the mammary gland, 



and later the lower deep cervical nodes 



are involved, and, as Snow has pointed 



out, regurgitation of lymph containing 

 ancer cells leads to retrosternal involve- 

 nent and to secondary cancer of the head 

 f the humerus. In operating for cancer 

 f the breast, follow the principle of Hal- 

 ted and remove the breast, the skin over 

 t, the muscles and fascia, the lymph 

 essel.s, and the axillary nodes in one 



>iece. By this plan thorough removal is possible, and as lymph vessels containing carcinoma 

 ells are not cut across, the wound is not grafted with malignant epithelial cells. Diseased 

 ixillary nodes are apt to adhere to the sheath of the vein. In removing cancerous nodes 

 ilwavs excise the sheath of the vein. 



FIG. 564. Lymphatic vessels of the dorsal surface of the 

 hand. (Sappey.) 



THE LYMPHATICS OF THE LOWER EXTREMITY. 



The Lymph Nodes of the Lower Extremity. 



The lymph nodes of the lower extremity consist of the anterior tibial node and 

 ;he popliteal and inguinal nodes. 



The anterior tibial node (lymphogland-ula tibialis anterior) is small and incon- 

 stant. It lies on the interosseous membrane in relation to the upper part of the 

 interior tibial vessels, and constitutes a substation in the course of the anterior 

 ibial lymphatic trunks. 



The popliteal nodes (lympkoglandulae popliteae], small in size and some six 

 >r seven in number, are embedded in the fat contained in the popliteal space, 

 lies immediately beneath the popliteal fascia, near the terminal part of the 



